A Tale of Two Graphs (and More); An Investigative History of America's Overdose Crisis by Amy Bianco got little notice when it was published back in May, probably due to its length.  We now have a Cliffs Notes edition by Lynn Webster at The American Council of Science and Health which should provoke some serious thought:

https://www.acsh.org/news/2025/11/21/tale-two-graphs-why-four-phase-opioid-story-falls-apart-49835

https://paingame.substack.com/p/a-tale-of-two-graphs-and-more

A Tale of Two Graphs – Why the Four-Phase Opioid Story Falls Apart
By Lynn Webster, MD — November 21, 2025

America’s overdose crisis isn’t the simple story we’ve been told for years. A new investigation reveals how two key graphs — one famous, one ignored — shift entirely the way we understand what happened, why deaths keep rising, and why current policies continue to fail. This op-ed explains why the familiar “four-phase opioid epidemic” narrative collapses under scrutiny.

For years, we’ve been told a simple story about the “opioid epidemic”: first, doctors prescribed too many pills, then reformulated OxyContin “drove” people to heroin, then fentanyl arrived, and now a wave of ultra-potent synthetics is killing “naïve” users in record numbers. Four neat phases, one neat villain: prescription opioids.

It’s a compelling narrative. It’s also deeply misleading.

A new multi-part investigation by journalist Amy Bianco at The PAIN GAME—“A Tale of Two Graphs (and More)” is, in my view, the clearest and most honest dismantling of that four-phase storyline that anyone has published to date.

Instead of starting with slogans or cherry-picked timelines, the author goes back to the graphs that shaped public policy: the classic CDC figure showing prescription opioid sales rising in lockstep with “prescription opioid deaths,” and the less famous but far more important Jalal/Burke graph showing that overall overdose deaths have risen on a smooth exponential curve since the late 1970s, across all drugs, long before OxyContin ever appeared.

Once you put those two graphs side by side, the four-phase myth starts to unravel.

What this series does differently

Most commentary treats “Phase One” as a morality play: greedy companies, gullible doctors, and passive patients whose prescriptions inevitably turned into addiction and death. This series refuses that caricature.

It shows how the modern pain movement began in oncology and AIDS care. This was a good-faith effort by clinicians who had seen opioids transform the lives of people in terrible pain, and who reasonably believed that carefully monitored use could help a wider group of patients. It traces how that model depended on time, expertise, and multidisciplinary care—psychology, physical therapy, and careful follow-up—not just a prescription pad.

Then it documents how the insurance industry quietly dismantled those comprehensive pain programs, reimbursing the cheapest elements and starving the rest. By 2015, the number of collaborative pain clinics in the U.S. had collapsed from roughly 1,000 to under 100 outside the VA. What survived in most communities was a 15-minute visit and a bottle of pills—not because physicians were lazy or corrupt, but because the system made everything else nearly impossible.

The piece also exposes something almost no one outside this world has seen: how overdose is coded and counted. “Prescription opioid deaths” on a CDC graph are usually multi-drug deaths where an opioid was present, not the proven cause. When a doctor is under investigation, the pressure on medical examiners to label a death as a “prescription overdose” can be intense—even when the patient had advanced heart disease, cancer, infection or, in one jaw-dropping example, died in a car crash.

Once you understand how messy the “opioid deaths” line really is, the simple Phase One story—“doctor prescribes → patient becomes addicted → patient overdoses”—looks much less like science and much more like a convenient political script.

Beyond four phases: waves, scams, and a rigged ecosystem

One of the most powerful sections comes from a methadone nurse in Maine who describes three overlapping waves of patients she saw between the late 1990s and early 2000s:

• long-time heroin users trying to stabilize
• abandoned chronic pain patients whose doctors cut them off
• young people getting hooked on diverted pills from medicine cabinets and the street

Those three waves alone blow up the idea that Phase One was mostly about “innocent patients turned into addicts by their prescriptions.” The reality was a tangled ecosystem where licit and illicit markets bled into each other, where diversion happened in countless small ways, and where the same pill could mean stability for one person and chaos for another.

The series goes further, tracing what it calls a “hierarchy of scams”: scammers who lied to doctors to get pills; law-enforcement strategies that turned those scammers into witnesses against high-volume prescribers; prosecutors who built careers by portraying pain specialists as kingpins; and insurers and government programs quietly saving money when those practices were shut down and complex patients scattered. All of this was then wrapped in the rhetoric of a new front in the War on Drugs: the “War on Prescription Drug Abuse.”

Meanwhile, as opioid prescriptions have fallen sharply since 2012, deaths from illicit fentanyl and its analogues have exploded. The second CDC graph of the article makes this brutally clear: prescribing plummets while the line of synthetic opioid deaths rockets upward. If pills were truly the singular engine of the crisis, those trends should move together. They don’t.

Why this matters now

If you live with pain, treat people in pain, or care about overdose policy, you already know something is off in the dominant story. Pain patients are being forcibly tapered or abruptly cut off. Clinicians are leaving the field in fear. Yet overdose deaths keep rising, driven by a volatile illicit market that our policies helped create.

Bianco’s series gives you the missing context and language to explain why.

It challenges the “magic molecule” theory which is the idea that a brief encounter with an opioid dooms a large share of people to lifelong addiction. If that were true, routine post-surgical prescribing over the last 50 years would have produced apocalyptic levels of opioid use disorder. It didn’t. The reality is far more nuanced, and far more tied to social conditions, trauma, and long-running failures of the War on Drugs than to any single product or prescription.

Most importantly, Bianco’s pieces insist on telling the story in all its messy, human detail: the patients who did everything “right” and were still treated as suspects; the young people who started using pills as teenagers because they were everywhere and life was hard; and the clinicians and law-enforcement officers who tried to do the right thing inside systems that rewarded spectacle over truth.

An invitation

If you’re tired of being told that the crisis can be explained in four tidy phases and one villain, I’d encourage you to read “A Tale of Two Graphs (and More)” and share it widely.

It doesn’t deny the harms of opioids or the responsibility of industry. It does something braver; it shows how partial truths, weaponized graphs, and a half-century of bad drug policy have combined to produce the catastrophe we’re in, and it explains why doubling down on the same narrative will only make things worse.

If we want policies that save lives and protect people in pain, we have to start by telling the story honestly. This series is a major step in that direction.

Lynn R. Webster, MD, is a pain and addiction medicine specialist and serves as Executive Vice President of Scientific Affairs at Dr. Vince Clinical Research, where he consults with pharmaceutical companies. He is also Senior Fellow, Center for U.S. Policy

Dr. Webster is the author of the forthcoming book, Deconstructing Toxic Narratives—Data, Disparities, and a New Path Forward in the Opioid Crisis, to be published by Springer Nature. He is not a member of any political or religious organization

Ms. Lyu's presentation did not address the increasing unaffordability of health care, which will undoubtedly constrain employment growth as all payers get tapped out:

https://house.mi.gov/Document/?DocumentId=59752&DocumentType=CommitteeTestimony

https://michiganadvance.com/2025/11/05/health-care-and-data-technology-jobs-predicted-to-increase-university-of-michigan-research-shows/

Health care and data technology jobs predicted to increase, University of Michigan research shows
By Katherine Dailey - November 5, 2025

Health care occupations, as well as data science and tech related jobs, are expected to see among the fastest growth in employment between now and 2032, according to a presentation from the University of Michigan’s Economic Growth Institute to the House Education and Workforce Committee on Wednesday.

“This reflects increasing demand for medical service, health care and data driven technologies,” said Mengjie Lyu, a senior researcher with the Economic Growth Institute.

For health care specifically, which is expected to increase by the highest number of jobs within the decade of 2022-2032 — nearly 47,000 jobs — Lyu added that this is “reflecting the impact of an aging population, the growing prevalence of chronic conditions, and higher levels of mental and behavioral health health service needs.”

On the other hand, mining is expected to decrease by the highest percentage of jobs in that time frame, while retail trade is expected to decrease by the greatest number of jobs.

Eight of the top 10 fastest growing occupations, Lyu noted, require at least a bachelor’s degree, and many require further education. The question of licensing and education was a further focus of the presentation.

“We definitely need this overview as we go into what other kinds of careers can we attach to a high school education, and how can we help students find their way earlier in their career track,” noted Rep. Nancy DeBoer (R-Holland), who chairs the committee.

“Michigan has fewer explicit occupational licenses than the national average,” Lyu stated. However, when looking at licensing barriers — additional requirements to do a job that are not directly attached to that career path — Michigan has significantly more than the national and regional averages.

“These licenses and license barriers are concentrated in four major occupation groups, including health care practitioners, technical construction and extraction, personal care and service, and community and social service,” Lyu added.

As for where job openings are coming from, the Economic Growth Institute’s research shows that, across industries, those are stemming from employees leaving a given industry — whether that be a career switch or retirement.

“In other words,” Lyu said, “the majority of available job postings are driven by replacement needs, rather than the net expansion of the occupations.”

“The top 10 occupations with the greatest annual job openings are primarily entry level service and support roles, such as food service retail and largely driven by turnover, rather than the net growth,” she added. “These roles typically require little formal education or experience and offer modest wages, highlighting the need for career development, design and retention strategies in entry level service jobs.”

Ashlee Breitner, the director of the Economic Growth Institute, added that she hoped that the data “will help inform policy discussions on education, licensing and talent development.”

https://www.clickondetroit.com/news/local/2025/08/08/assisted-living-center-in-westland-announces-sudden-closure-amid-history-of-violations/

Assisted living center in Westland announces sudden closure amid history of violations
The company announced at the end of July that all residents would have to vacate by Sept. 1
Assisted living center in Westland announces sudden closure amid history of violations
By Noelle Friel - August 7, 2025

WESTLAND, Mich. – Management of an assisted living facility in Westland announced it would be closing its doors, giving residents just over a month to relocate.

The facility, which offers assistance through the Section 8 Housing Choice Voucher Program, was taken over by the company Alcore Senior four years ago.

The company shared the decision at the end of July, announcing that all residents would have to vacate by Sept. 1.

The company provided the following statement to Local 4:

“We took over The Westland House after it had already defaulted and was in serious decline. Despite investing over $3 million and doing everything we could to turn it around, the lasting effects of prior mismanagement, COVID, and rising care needs made recovery impossible.

We’ve worked closely with HUD on a responsible closure and are helping every resident transition safely to nearby communities. We’re grateful to the families, staff, and community who stood by us throughout this effort."

Reports from the Michigan Department of Licensing and Regulatory Affairs (LARA) reveal 25 separate investigations conducted regarding complaints made about the facility dating back to 2022.

A report from January 2025 revealed that expired medications were found in the staff’s medication carts, and shower logs were incomplete, making it impossible to determine whether residents were being showered consistently. Additionally, one resident was found to have an untreated open sore to the bone.

A report from August 2024 found that residents’ medications were being administered either too early or too late and were not administered according to the prescribing healthcare professional’s orders. The report again found that a resident’s wounds were not being consistently treated.

In a report from September 2023, two staff members reportedly stated that many of the residents’ call lights were “broken” and experienced delays in call light response times because they were not notified when the light was on. All of the reports can be accessed on LARA’s website.

Executive Vice President of Alcore, Senior Chris Schott, acknowledged the reports, stating that the company had obtained a “Home for the Aged” (HFA) exempt license and began outsourcing medical care through a third-party company, The Medical Team, to improve residents’ care.

Two former employees, Brielle Daniels and Brianne Brewer, claim they continued serving meals to residents until a week before the facility announced its decision to close.

Both reported seeing cases of residents being neglected.

“When we do trays, we go in their rooms, and we can call for somebody for help, and they’ll still be on the floor for like three hours,” Daniels said. “It could be a whole day if it turns out to be.”

“If their light is on, we can call on the walkie and say such and such needs assistance, the light will still be going off two hours later,” Brewer said.

Both said the decision to close didn’t come as a surprise.

“For them to give them 30 days, knowing some of these people don’t have families, they haven’t been in contact with for years, it’s just unfair for the residents,” Brewer said.

Schott said the company is working diligently with HUD to connect residents with other housing options and noted that 22 of the facility’s 30 residents have already found new housing.

He also said that once the facility closes, the company plans to work with the city of Westland to convert the property into more affordable housing.

https://content.govdelivery.com/attachments/MIEOG/2025/06/23/file_attachments/3301089/LARA%20Draft%20Reproductive%20Health%20Correspondence%20to%20Hospitals%2006.13.2025%20Generic%20to%20State%20Regulations%20062025.pdf

https://michiganadvance.com/2025/06/24/on-dobbs-anniversary-michigan-reminds-hospitals-of-their-reproductive-health-care-responsibilities/

On Dobbs anniversary, Michigan reminds hospitals of their reproductive health care responsibilities
By Jon King - June 24, 2025

An order issued Tuesday by the Michigan Department of Licensing and Regulatory Affairs reiterated to Michigan hospitals their responsibilities “to continue providing adequate and appropriate reproductive care to patients.”

The notice came on the three-year anniversary of the U.S. Supreme Court’s Dobbs decision that overturned Roe v. Wade, and ended nearly 50 years of a constitutional right to an abortion.

It also follows a decision earlier this month by the U.S. Department of Health and Human Services to rescind guidance that emphasized hospitals are responsible for providing emergency abortion care despite state bans, saying it does not reflect the Trump administration’s policy.

“Due to recent federal action taken and guidance issued, the Department of Licensing and Regulatory Affairs reminds you that the Emergency Medical Treatment and Labor Act (EMTALA) remains in force, including its requirement to provide screening and appropriate follow up care,” the notice stated.

Gov. Gretchen Whitmer’s office said the decision to rescind the guidance will place thousands of lives at risk by restricting women’s ability to access appropriate emergency health care.

“Here in Michigan, we believe everyone deserves the freedom to make their own decisions about their reproductive health,” Whitmer said in a press release. “We trust women to make decisions that are right for their bodies, lives, and futures. I’ll keep fighting like hell to protect your freedoms.”

The notice makes clear to Michigan hospitals that the state’s authority on reproductive health issues is not preempted by decisions made by the federal government. It also says that while state-licensed health facilities and agencies aren’t required to admit patients for the purpose of performing an abortion, they “are still required to offer adequate and appropriate care for the services they provide.”

In its press release, Whitmer’s office states that by not enforcing the Emergency Medical Treatment and Labor Act, the Trump administration is “providing cover to hospitals systems that have ideological opposition to abortions, putting the life of the mother at risk in the process.”

Meanwhile, reproductive rights advocates note that in the three years since Roe was overturned, more than 20 states have severely restricted or placed outright bans on access to abortion. Combined with a lack of clarity around the responsibilities of hospitals in those states to provide appropriate care, those advocates say the result has been a number of preventable deaths.

“Knowing this, the Trump administration still revoked Biden-era guidance around lifesaving emergency care, making their stance as clear as ever: when faced with a life or death situation, they do not care if pregnant people die,” Paula Thornton Greear, president and CEO of Planned Parenthood of Michigan, said.

Whitmer also expects that Trump’s decision to rescind the federal guidance will result in additional residents in states like neighboring Indiana that have abortion bans to seek reproductive health care in Michigan. That could place a strain on resources and potentially limit the services offered by Michigan hospitals, Whitmer said.

Mackinac Center's 3-member panel gives cogent reasons for reform, and citing three recent presidents and Governor Whitmer, among others.

Refreshingly, it calls for legislative skepticism of special interest experts.

This 1-hour video of the recent symposium is well worth your time.

https://www.youtube.com/watch?v=AzXQdjm-Txo&t=1s

1. Implementing the best of LARA’s recommendations to streamline the state’s licensing
process while cutting out unnecessary barriers. Roughly 75% of the Department’s
recommendations are good policy and reduce red tape. Those are the recommendations
the Rules Committee will pursue. Some recommendations were not included due to
differences in policy preference, stakeholder feedback, and recommendations that
created additional red tape.

2. Review and adjust Michigan’s licensing regime to get the government out of the way of
pursuing a licensed profession in Michigan.

3. Implement meaningful reforms of Michigan’s regulatory and permitting system to make
Michigan a top state to start a business, a family, and a career.

This initiative follows a February 2025 LARA report which made some fairly innocuous recommendations to cut red tape:

https://dtj5wlj7ond0z.cloudfront.net/uploads/2025/06/Rules-Committee-Report-final.pdf

https://www.michigan.gov/lara/-/media/Project/Websites/lara/about/LARA_CuttingRedTapeReport-1.pdf

https://www.wlns.com/capital-rundown/michigan-house-republicans-propose-ways-to-cut-red-tape/

Michigan House republicans propose ways to cut red tape
By Duncan Phenix - June 12, 2025

LANSING, Mich. (WLNS) — Michigan House republicans are releasing a report they say shows how to confront “the problem of excessive state regulations, which create barriers and increase costs for skilled workers, small businesses, health care providers, and homebuilders.”

In a news release, they claim, “There is bipartisan agreement that Michigan should cut this unnecessary red tape. Gov. Gretchen Whitmer called for streamlining licensing and permitting during her State of the State Address in February.”

On Thursday, a group of republican lawmakers with the House Rules Committee is releasing their Red Tape Reduction Initiative to “lay out a plan for restoring common sense to Michigan`s state government.”

https://www.dbusiness.com/daily-news/michigan-health-council-details-solutions-to-health-care-workforce-challenges/

https://www.mhc.org/workforceplan

https://www.mhc.org/_files/ugd/24abcc_b5f61284ac314223ae01cfcea5e28616.pdf

Michigan Health Council Details Solutions to Health Care Workforce Challenges
The Michigan Health Council (MHC) in Okemos, near Lansing, has released a new plan aimed at guiding the implementation of data-driven solutions to the state’s future health care workforce challenges.
By Tim Keenan - April 30, 2025

As Michigan’s population ages and many health care providers near retirement age, the Michigan Health Council has released a new plan to guide the implementation of data-driven solutions to the state’s future health care workforce challenges. // Stock photo
The Michigan Health Council (MHC) in Okemos, near Lansing, has released a new plan aimed at guiding the implementation of data-driven solutions to the state’s future health care workforce challenges.

Key recommendations of the 2025 Michigan Healthcare Workforce Plan include strengthening existing statewide health care career awareness, exploration, and preparation activities; expanding partnerships between education and health care settings to reduce geographical and other barriers to earning a health care certification or degree; and focusing on understanding health care staffing and retention across the state.

“Michigan stands at a critical crossroads,” says Craig Donahue, president and CEO of MHC. “Our aging population is driving increased health care demand, our current health care workforce is approaching a retirement cliff, and we continue to struggle getting people into the workforce pipeline.

“The time for decisive action is now to ensure quality healthcare remains accessible for all Michiganders. We see the Workforce Plan as an opportunity to engage stakeholders in the work of implementing solutions.”

Supported by the Michigan Health Endowment Fund, the Workforce Plan is built on a framework consisting of four key pillars:

Grow Interest in Health Care Careers – Expanding career readiness opportunities for students through enhanced K-12 career development, increased job shadowing and observation experiences, and targeted student engagement programs.

Improve Access to Health Care Education – Removing barriers to healthcare education by expanding collaborative programs, increasing the availability of healthcare apprenticeships, and improving transfer pathways to make healthcare education more accessible and affordable.

Increase Experiential Education Capacity – Addressing the shortage of clinical placement sites and educators by expanding the use of alternative training sites, supporting and incentivizing clinical faculty and preceptors, and collecting data to better understand and utilize clinical capacity.

Explore Recruitment and Retention Strategies – Encouraging partnerships that build local talent pipelines, improving access to career development opportunities for all healthcare workers, and better understanding turnover using data.

“The health of Michigan residents is intrinsically linked to the state of our health workforce. That is why this report is important,” says Kari Sederburg, vice president for programs and director for healthy aging at the Michigan Health Endowment Fund.

“By providing training pathways, recruitment, and retention recommendations, the report speaks to workers’ needs throughout their careers. Helping our health professionals thrive requires a shared vision and aligned actions to meet our communities’ health needs today and tomorrow.”

Officials say the Workforce Plan has been informed by data analysis and research, including the Michigan Healthcare Workforce Index, a first-of-its-kind product of MHC that assessed the health of 36 health care occupations in Michigan based on four inputs — wages, growth, shortages, and turnover–to determine how each occupation is faring in our economy.

“The next step is critical,” Donahue says. “This plan comes to life when stakeholders engage with each of the Workforce Plan’s proposals, putting into motion actionable solutions critical to the future health of Michiganders.”

https://www.realclearmarkets.com/articles/2025/04/26/its_not_doctors_the_real_worker_shortage_in_healthcare_1106482.html

It's Not Doctors: The Real Worker Shortage In Healthcare
By Craig Sprinkle - April 26, 2025

Perhaps under the radar for most, given the seismic shifts in our news cycle on a near-daily basis, it must be said that America’s healthcare industry is currently grappling with a severe workforce crisis – particularly among allied healthcare professionals.

While in years past, much attention may have been given to shortages of doctors and nurses, more than 60% of healthcare vacancies are in allied health roles. These include medical assistants, lab technicians, and other essential support staff, all of whom play a critical role in day-to-day patient care.

Make no mistake - Without these professionals, healthcare systems would be unable to operate, and the shortage of such workers is being keenly felt.

One of the most pressing issues driving this crisis is a severe imbalance between the demand for skilled healthcare workers and the available supply - A 2022 report from the U.S. Bureau of Labor Statistics (BLS) estimates that the healthcare sector will need to add around 2.3 million jobs by 2031 to meet rising demand. However, many of these roles remain vacant due to barriers such as a lack of sufficient training, certification programs, and education pathways that meet the evolving needs of the sector.

According to the BLS, over 250,000 healthcare job openings exist at any given time, with an increasing number going unfilled because the labor pool does not have the skills required.

This mismatch between what employers need and what workers are trained for contributes significantly to high turnover rates in the healthcare sector in 2025.

So, what can be done? Well, a central factor in alleviating the healthcare workforce crisis lies in addressing the skills gap.

Employers are not only struggling to recruit qualified professionals, but also to retain them. A large part of this challenge stems from the fact that many candidates lack the specific certifications and skills that employers seek. This issue can be compounded by a lack of career advancement opportunities, which contribute to higher turnover rates in healthcare organizations.

Various organizations have stepped in to provide targeted certification programs designed to equip workers with the essential skills needed in today’s healthcare environment. For example, in medical assisting, certification rates are closely tied to both improved employment outcomes and increased job satisfaction. According to a 2020 survey by the American Association of Medical Assistants, 89% of employers prefer to hire certified medical assistants, underscoring the importance of professional certification.

The healthcare industry is constantly evolving, which means the demand for workers with updated skills is also changing. Training programs must thus adapt to reflect the latest technological and medical advancements.

Educational programs that combine technical certifications with soft skills such as teamwork, problem-solving, and communication are also becoming increasingly important. These non-technical skills are essential in healthcare settings, where collaboration is crucial.

Programs that incorporate real-world simulations and hands-on learning can ultimately help prepare workers for the complexities of the job.

Technological advancements are also playing a significant role in reshaping healthcare training. Modern educational models are incorporating more interactive and immersive methods; simulations of real-world scenarios—such as virtual patient interactions, for example—allow students to practice critical skills in a safe and controlled environment before they enter clinical settings.

These tools, powered by AI and other emerging technologies, have shown to be highly effective - For example, a 2021 study in the Journal of Medical Education found that virtual simulations improved the performance of students in clinical skills by 30% when compared to traditional classroom-based methods.

These innovations not only improve the quality of training but also make it more accessible. Online courses, which can be completed on flexible schedules, are especially important for individuals who cannot commit to full-time, in-person education due to work or family obligations.

However, the rising cost of higher education is but another factor contributing to the workforce crisis.

As tuition rates soar, many potential healthcare workers are deterred from pursuing degrees that often require years of study and significant debt.

In contrast, certification programs offer a more affordable and accessible route into the healthcare field. According to the National Center for Education Statistics, the cost of a bachelor's degree can exceed $30,000 per year, while certification programs can cost a fraction of that and take much less time to complete.

These certification programs also offer a pathway for career progression. Many workers can start with entry-level certifications and gradually build on them to attain higher-paying roles.

While the workforce crisis is particularly acute in healthcare, other sectors are also facing similar challenges. Skilled trades and IT sectors are experiencing shortages of qualified workers. The U.S. Chamber of Commerce reports that nearly 80% of employers in the construction industry are struggling to find workers, for instance, with similar issues facing industries like manufacturing and information technology.

The model of certification-based, career-focused training can be applied to these sectors as well. A growing number of training programs are emerging to address shortages in fields such as IT and advanced manufacturing. For instance, the IT industry is projected to add 500,000 new jobs in the next decade, many of which require specific certifications in software development, cybersecurity, and network administration.

As the workforce crisis continues to evolve, it is essential to acknowledge the role of artificial intelligence (AI) in shaping future job opportunities. But, while AI is expected to automate certain tasks, it cannot replace the need for human workers who bring critical thinking, empathy, and problem-solving abilities to the table. For instance, in healthcare, AI tools can assist with administrative tasks like patient scheduling or data entry, but they cannot replace the need for skilled clinicians who provide direct patient care.

The workforce crisis in healthcare and other sectors is a pressing challenge that requires immediate attention. By providing accessible, targeted training programs and certifications, we can help close the skills gap and equip workers with the tools they need to succeed.

Addressing this issue is critical not only for employers who are struggling to find qualified talent but also for individuals seeking rewarding, well-paying careers in fields that are growing rapidly.

As the demand for healthcare services and other specialized roles continues to rise, effective solutions will require collaboration between educational institutions, employers, and technology developers.

Time is of the essence, and the need for skilled professionals in healthcare and beyond has never been greater.

https://www.detroitnews.com/story/opinion/2025/04/16/hoekstra-michigan-weaponizes-healthcare-licensing-for-ideology-not-medicine/83118880007/

Hoekstra: Michigan weaponizes healthcare licensing for ideology, not medicine
By Kathy Hoekstra - April 16, 2025

In her recent State of the State address, Gov. Gretchen Whitmer called for bipartisan collaboration on occupational licensing reform.

As Michael Reitz pointed out in a March 18 op-ed for the Mackinac Center, that invitation is welcome — professional licensing in Michigan has become excessively burdensome.

This news should especially resonate with Michigan’s barbers, whose 1,800-hour training requirement starkly contrasts the governor’s pandemic advice to simply “Google how to do a haircut or throw your hair in a ponytail.”

To be fair, Whitmer did relax some healthcare licensing regulations during the pandemic, albeit temporarily.

But there’s one pandemic-era edict still standing that has nothing to do with healthcare and everything to do with ideology.

It’s mandatory implicit bias training, and it’s unconstitutional.  The mandate emerged in the summer of 2020 when Gov. Whitmer issued executive directives ordering the Michigan Department of Licensing and Regulatory Affairs (LARA) to establish implicit bias training standards for the state’s 400,000-plus healthcare professionals.

In her directives, Whitmer characterized implicit bias as unconscious “thoughts and feelings” that “are difficult to control” yet “can shape behavior,” and its injection into healthcare licensing is necessary to serve her stated agenda of “addressing racism as a public health crisis.”

With few exceptions, this sweeping mandate applies across all healthcare fields — from dentistry, nursing and physical therapy to social work, acupuncture and marriage counseling.

Even radiologists, who rarely meet their patients face-to-face, must comply or face severe consequences.Since September 2024, LARA has fined at least 132 healthcare professionals nearly $76,000 for failing to meet this requirement. Others have had credentials suspended or surrendered their licenses rather than comply — exacerbating Michigan’s healthcare worker shortage.The impact is not just professional; it’s personal.

Take Dr. Kent Wildern, a longtime Grand Rapids dentist who, for 40 years, provided free dental care to underprivileged children alongside his practice. The new mandate presented him with a gut-wrenching choice: comply with the irrelevant and controversial training of dubious value or abandon his profession. He chose his principles, letting his dental license lapse even though it meant he couldn’t continue the work he loves, not even for charity.

Beyond its irrelevance, this mandate has critical legal problems that the governor should have recognized from the start.  The mandate came from LARA, an administrative agency, rather than the legislature. State law allows LARA to set standards for clinical skills necessary for practice only, not broad social policy initiatives.  Even if the law could somehow be construed as giving LARA’s unelected bureaucrats the power to weaponize the licensing process to promote race-essential viewpoints, the law would run afoul of the Michigan and U.S. Constitutions.

In addition to exceeding its authority, LARA’s ideological requirements for professional licensure violate citizens’ fundamental rights to earn a living and freedom of thought.

Michiganians deserve healthcare professionals selected for their medical expertise, not their compliance with disputed social theories. And our healthcare professionals deserve to obtain and renew their licenses without undue and unnecessary government interference. LARA’s unlawful licensing mandate denies both.  Represented at no charge by Pacific Legal Foundation, where I work, Wildern is challenging LARA’s authority with a lawsuit in the Michigan Court of Claims.

As his battle moves through the courts, policymakers of all stripes should recognize that meaningful licensing reform isn’t just about reducing hours or streamlining processes.

It’s about ensuring regulations serve legitimate public health and safety purposes, not advancing ideological agendas.  Let’s hope the bipartisanship Whitmer spoke of extends to eliminating this unjust licensing burden for quality healthcare, professional dignity and constitutional governance.

https://www.cato.org/blog/chilling-effect-how-fear-drives-doctors-away-pain-patients

The Chilling Effect: How Fear Drives Doctors Away from Pain Patients
By Jeffrey A. Singer - February 25, 2025

When Mark Ibsen, MD, spoke as a panelist in the Cato online event “Pain Refugees: Collateral Damage in the War on Drugs” last December, he had no idea that representatives of the Montana Board of Medical Examiners (BOME) were watching. Three days later, he was shocked to receive a letter from BOME demanding he justify mentioning deceased patients by name (possibly violating the Health Insurance Portability and Accountability Act, or HIPAA)—a charge that would later be dropped but sent a clear message: speaking out has consequences. The letter stated:

While investigating the original Complaint, the Department became aware that you identified six former patients by name in the following online forums, which were available to the public:

1) December 22, 2019, written post responding to a blog article entitled “No Help, no medication. I want out. I’m not strong enough” on the Pharmacist Steve website.

2) October 6, 2020, video post on your Facebook page.

3) December 2, 2024, video post on your Facebook page.

4) December 3, 2024, panel discussion hosted on the Cato Institute’s website and video post of the panel discussion on that website.

… Please provide a written response to these additional allegations by the end of the day on December 16, 2024. Please include in your response whether you had written permission from your former patients or other legally authorized individual to disclose the patient’s protected health information in a public setting. If so, please provide copies with your response. (emphasis added)

In 2015, agents from the Drug Enforcement Administration (DEA) raided the office of Christopher Christensen, a Montana physician who was then 67 years old, and arrested him for inappropriately prescribing opioids to his patients. The DEA charged Dr. Christensen with 400 felony drug offenses and two counts of negligent homicide following the overdoses of two patients who had taken his prescribed medication. A jury convicted Christensen in 2017, and the court sentenced him to 20 years in prison, 10 of which were suspended. The Montana Supreme Court overturned the negligent homicide convictions but still required him to serve time in prison for nine counts of criminal endangerment and 11 counts of criminal distribution of dangerous drugs.

Dr. Christensen’s arrest by cops practicing medicine frightened Dr. Ibsen, a Montana primary care and urgent care physician. Dr. Ibsen wrote me: “Before ceasing writing prescriptions for opiates, reported DEA incursions had me thinking that every opiate prescription I wrote could be my last. I worried if I could trust patients to honor their promise that they would not kill themselves with my prescription, as that would take me down as well.” He ceased prescribing opioids for pain in 2017. “I thought I was going to be given an award for weaning 80% of my patients off opioids.”

He tapered his patients’ doses, gave them notice that he would no longer treat them, referred them to other doctors, and prescribed them a 30-day supply of pain medications to tide them over until they saw the other doctors. Unfortunately, other doctors were oftentimes afraid of taking on new pain patients. Some of Ibsen’s former patients grew desperate, and like many across the country in similar straits, some turned to suicide.

At Cato’s pain refugee event, Dr. Ibsen, holding back tears, stated:

Six of my patients died from 2016 to 2018 after I stopped prescribing opiates when Dr. Chris Christensen was convicted. Three of my patients died by gunshot wounds … two by alcohol complications … and one by a non-opioid overdose: Chris Storseht — Jennifer Adams – Robert Mason – Jennifer Beausoleil – John Burke- Lynette Chadwick.

At the BOME Screening Panel hearing this month, the BOME attorney never mentioned HIPAA violations when summarizing the Board’s concerns. The physician chairing the panel didn’t mention HIPAA violations either.

One of Dr. Ibsen’s chronic pain patients from 2013 provided an affidavit stating:

Information, pictures, and names of chronic pain patients who committed suicide, have been public knowledge for a number of years. … There was a conference put on by the Helena Department of Public Health & Human Services in 2018. A few of us chronic pain patients that belong to an organization called “Don’t Punish Pain” were invited to be on a panel. We talked about, (six) chronic pain patients just in Montana! We held up their pictures as we said each of their names.

But the affidavit wasn’t needed. The panel voted to terminate the investigation.

This might end the Board’s persecution of Dr. Ibsen, but he will always be haunted by the memories of pain patients who suffered so much that they took their own lives.

Ibsen’s story is emblematic of a broader pattern: regulators and law enforcement drive physicians out of pain management, leaving patients nowhere to turn. His decision to stop prescribing opioids after Dr. Christensen’s conviction—out of fear that he could be next—shows the chilling effect of aggressive prosecution. And the tragic outcome for his former patients mirrors what has happened nationwide as pain management has been criminalized.

Jeffery A. Singer has a new book out on April 8th: Your Body, Your Health Care.