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Supreme Court Hears Case of Doctors Accused of Running Pill Mills

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Supreme Court Hears Case of Doctors Accused of Running Pill Mills

WASHINGTON — Towards the backdrop of a nationwide disaster of hovering opioid overdoses and deaths, the Supreme Courtroom on Tuesday thought-about the circumstances of two docs accused of working capsule mills, with the justices struggling to articulate a authorized commonplace that will separate unconventional medical practices from drug dealing.

They parsed the language of the Managed Substances Act, recalling classes realized from childhood grammar academics. They tried out analogies, together with whether or not there’s ever a good-faith exception to exceeding the velocity restrict. And so they anxious about sending docs to jail for many years over disputes about whether or not they had violated ill-defined medical norms.

The docs within the two circumstances have been convicted of illegal drug distribution. One, Dr. Xiulu Ruan, was accused of working a clinic in Alabama with a enterprise companion that issued almost 300,000 prescriptions for managed substances in somewhat greater than 4 years, making it one of many nation’s main sources of prescriptions for some sorts of fentanyl medication.

The opposite, Dr. Shakeel Kahn, was accused of writing prescriptions in Arizona and Wyoming in alternate for funds that roughly tracked the road costs of the medication. Prosecutors stated he had accepted cost in money and private property, together with firearms.

The query for the justices was learn a phrase in a regulation underneath the Managed Substances Act. The phrase set out an exception to the regulation’s prohibition and penalties, for prescriptions that have been “issued for a reliable medical goal by a person practitioner appearing within the common course of his skilled observe.”

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Eric J. Feigin, a lawyer for the federal authorities, stated that exception described an goal commonplace rooted in established medical norms, one which the 2 docs had ignored.

“They wish to be freed from any obligation even to undertake any minimal effort to behave like docs once they prescribe harmful, extremely addictive and, in a single case, deadly dosages of medication to trusting and susceptible sufferers,” he stated.

Legal professionals for the docs stated the proper commonplace was a subjective one, centered on whether or not they had acted in good religion even when their conduct was at odds with typically accepted medical practices.

“The issue is that medical requirements evolve,” stated Lawrence S. Robbins, a lawyer for Dr. Ruan. “It’s a continually evolving matter. And that deference to sufferers and their sickness and their docs requires a subjective commonplace.”

Beau B. Brindley, a lawyer for Dr. Kahn, warned of a “horrible chilling impact” that will outcome from turning the Drug Enforcement Administration into “a de facto nationwide medical board.”

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Chief Justice John G. Roberts Jr. stated that subjective understandings didn’t typically create a protection to legal costs.

A motorist stopped for driving 70 miles per hour when the velocity restrict was 55 might have believed the restrict was 70. “You continue to get the ticket, proper?” Chief Justice Roberts requested.

Mr. Robbins stated that totally different guidelines utilized for critical legal costs.

“You don’t get to defend the visitors violation primarily based in your mind-set,” he stated, including that extra was required “whenever you’re speaking about sending docs, or anyone for that matter, to jail for obligatory minimums of many years in jail.”

Justice Amy Coney Barrett proposed what she steered was a better analogy. Suppose, she stated, {that a} legal statute offers, “Besides as approved by regulation, you need to drive underneath 55 miles per hour.”

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Motorists driving a lot sooner to deliver an injured baby to an emergency room, she stated, would possibly incorrectly however in good religion perceive the exception to use to them.

Justice Brett M. Kavanaugh agreed. “If the statute says ‘besides as approved’ and also you sincerely consider you’re approved to drive 100 to get your baby to the hospital, you have to be acquitted, proper?” he requested.

Justice Kavanaugh then turned to the circumstances earlier than the court docket, Ruan v. United States, No. 20-1410, and Kahn v. United States, No. 21-5261.

“The physician might have violated that goal commonplace however might need legitimately thought that the usual was considerably totally different and, subsequently, in these circumstances shouldn’t be despatched away for 20 years to jail, proper?” he requested.

Justice Samuel A. Alito Jr., drawing on what he had realized from “my outdated English instructor,” stated the position of the phrase “knowingly and deliberately” within the statute, after the exception on which the docs relied, meant it didn’t apply to the exception, undercutting the docs’ argument that subjective good religion issues.

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The grammatical flaws within the docs’ arguments didn’t cease there, Justice Alito stated. “The issue is what an adverb can modify,” he stated. “It could actually solely modify a verb.”

Justice Stephen G. Breyer disagreed, recalling his personal faculty days.

“I had a distinct English instructor, Ms. Chichester,” he stated, “who informed us an adverb might modify a verb, an adjective or one other adverb.” (Most authorities would agree that Justice Breyer is precisely proper.)

Sounding somewhat rueful, Chief Justice Roberts stated, “I can’t bear in mind my grammar instructor’s title.”

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Elton John’s vision loss: How an eye infection can cause blindness

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Elton John’s vision loss: How an eye infection can cause blindness

World-renowned singer-songwriter Elton John confirmed he has lost sight in his right eye after suffering from a severe infection.

On the opening night of his musical adaptation of “The Devil Wears Prada” in London, John shared, “I haven’t been able to come to many of the previews because, as you know, I have lost my eyesight.”

“So, it’s hard for me to see it, but I love to hear it and, boy, it sounded good tonight,” he said.

ELTON JOHN HAS ‘LOST MY EYESIGHT’ FOLLOWING SEVERE INFECTION

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John first posted to his Instagram account in September that he had been dealing with a “severe eye infection” over the summer that has “unfortunately left me with only limited vision in one eye.”

“Since Sir Elton John did not state what type of eye infection he has, it is unclear whether he has complete blindness in his right eye or if there is still some partial vision,” Dr. Thuy Tran, optometrist and founder of Oculist in New York City, told Fox News Digital. 

“It is possible that he may still be able to perceive light and motion, but is unable to discern enough details to read letters or musical notes,” added Tran, who did not treat the singer. 

“He may also be experiencing other signs and symptoms, such as thick mucous discharge, pain, irritation, excessive tearing and redness.”

Types of eye infections

The most common types of eye infections are viral conjunctivitis and bacterial conjunctivitis, according to Tran.

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“Viral conjunctivitis, caused by adenovirus, are like common colds and typically resolve on their own within a few weeks,” he said.

“When caused by herpes simplex virus, varicella zoster virus (same virus that is responsible for chicken pox and shingles), or cytomegalovirus (seen in immunocompromised individuals i.e. those with HIV/AIDS), more serious complications, such as corneal scarring, retinal damage and vision loss, may result.”

ASK A DOCTOR: ‘WHY ARE MY EYES OFTEN BLOODSHOT?’

Bacterial eye infections usually resolve within a week with proper antibiotic treatment, usually eyedrops or ointment, the doctor noted.

“A hyperacute bacterial eye infection, however, can be severe and rapidly progressive,” Tran warned. “If not treated immediately, it can lead to corneal ulcers, scarring and blindness.” 

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“This condition is most commonly caused by Neisseria gonorrhoeae, a type of bacteria that can be transmitted through sexual contact.”

Bacterial eye infections usually resolve within a week with proper antibiotic treatment, usually eyedrops or ointment. (iStock)

Fungal eye infections are often caused by fungi that are naturally present in our environment, according to Tran.

“Common risk factors include trauma to the eye with plant material, extended contact lens wear and diabetes,” he said.

Fungal infections are usually treated with topical or oral antifungal therapies. 

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“Rarely, they can lead to a medically-urgent condition known as endophthalmitis, which often requires hospitalization for administration of intravenous medications.”

Potential for permanent damage

Dr. Derek Cunningham, eye doctor and director of Dell Laser Consultants in Austin, Texas, also spoke with Fox News Digital about the dangers of both internal and external infections in the eyes.

JULIE BOWEN OF ‘MODERN FAMILY’ GETS REAL ABOUT CHRONIC DRY EYE: WHAT TO KNOW ABOUT THE PROGRESSIVE CONDITION

An internal infection can be caused by a virus, said Cunningham, who also did not treat Elton John. If it reaches the retina, or the back of the eye, permanent vision loss can occur.

More commonly, eye infections are the result of external triggers and trauma to the front of the eye, like scratches, chemical splashes or the misuse of contact lenses, he noted.

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elton john on stage

Elton John speaks onstage during the 38th Annual Rock & Roll Hall Of Fame Induction Ceremony at Barclays Center on Nov. 3, 2023, in New York City. (Theo Wargo/Getty Images for The Rock and Roll Hall of Fame)

These incidents then allow bacteria and other foreign organisms to “colonize in the eye,” Cunningham said.

“Because [the eye] is specifically designed to transmit light, the cellular structure of all the tissues is very precise, and it cannot be altered.”

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“So, any amount of immune response or even bacterial or viral infection is going to cause not only a disruption in the cells, but it could potentially cause scarring – and that is going to reduce vision, very often on a permanent level,” he went on.

While the eye is sensitive and may have a harder time warding off infection since it’s a “compartmentalized” system, Cunningham said, the cornea is also the “fastest-healing tissue in the human body.”

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Doctor performs an eye examination on a patient

Eye infections are more likely to affect the elderly, according to an expert. (iStock)

But as people age, the body heals more slowly – so someone like John, who is 77 years old, will be at a higher risk of elongated infection compared to those who are younger.

“A little kid can scratch their eye and within hours be completely healed,” Cunningham said. “In an elderly person, [injury] can last for days, and that’s where the chance of infection builds up – every minute that the tissue is still compromised.”

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Some eye complications can be spotted and addressed early on during routine eye exams.

Cunningham recommends paying attention to visual function – and if vision is compromised, symptoms should be evaluated by a doctor.

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If vision is compromised, symptoms should be evaluated by a doctor, an expert recommended. (iStock)

“If there is … anything really infectious in the eye, the potential for vision loss is extremely high — and it’s permanent. It very often doesn’t ever come back.”

Representatives for John did not return Fox News Digital’s immediate request for comment.

Fox News Digital’s Elizabeth Stanton contributed to this report.

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Doctor and cancer survivor gears up to run 7 marathons on 7 continents in 7 days

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Doctor and cancer survivor gears up to run 7 marathons on 7 continents in 7 days

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A Wisconsin doctor is gearing up for the feat of a lifetime in order to spread awareness about the most pervasive cancer impacting young men.

Dr. T. Clark Gamblin, a surgeon in Milwaukee, spoke with Fox News Digital about his upcoming participation in the World Marathon Challenge. The competition involves running seven marathons on seven continents – seven days in a row. 

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The first marathon will take place in Antarctica on Jan. 31, 2025. From there, Gamblin and other participants will travel to Cape Town, South Africa; Perth, Australia; and Dubai, UAE. 

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From there, Gamblin will jet to Madrid, Spain, and Fortaleza, Brazil, before running a final race in Miami. He and his fellow marathon runners will have logged 183 miles over the course of a week.

Dr. T. Clark Gamblin, a cancer surgeon who battled testicular cancer, is running in the World Marathon Challenge, which involves running seven marathons on seven continents – seven days in a row. (Jan Gamblin, Ph.D.)

The fast-paced nature of the competition means that it won’t exactly be a relaxing vacation for the participants.

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“Over the course of the seven days, we’ll spend about 60 hours on the plane,” Gamblin said. “So it’s running, and it’s plane, and it’s running, and then it’s plane.”

“If you’re prepared and you train correctly, it’s not some Herculean feat.”

While it may seem physically impossible for a human to run seven marathons in seven consecutive days, the World Marathon Challenge has taken runners across the world for nearly a decade. Gamblin began training for the race a year ago.

“It’s a physical challenge, there’s no doubt about it, but there are much more physically demanding things that people have done,” he said. “If you’re prepared and you train correctly, it’s not some Herculean feat.”

AFTER A BREAST CANCER DIAGNOSIS, HERE ARE 10 IMPORTANT THINGS YOU SHOULD DO, EXPERTS SAY

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Gamblin has a whole team behind him. The World Marathon Challenge organization handles the logistics of all participants’ flights and hotels. A cancer surgeon, Gamblin also enlisted the help of a dietitian at his hospital to help him meet his protein and fluid goals.

He also has a physical trainer to help with injury prevention — but the person who has helped Gamblin the most, he said, is his wife.

Split image of Gamblin smiling and talking to patient

Dr. T. Clark Gamblin spoke to Fox News Digital about his participation in the World Marathon Challenge. (Fox News Digital / Jan Gamblin, Ph.D.)

“She’s like my No. 1 cheerleader,” Gamblin said. “She’s not a big runner, but she’s a huge part of helping me get ready for this and preparing me for it.”

“But then right behind her would be my running coach, a dietitian and a physical therapist. So it does take a team to get ready for something like this.”

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Gamblin, who specializes in liver and bile duct cancer, became interested in running marathons as a medical school student. During the World Marathon Challenge, he will be running for the Testicular Cancer Awareness Foundation. 

The cause is near to his heart, as Gamblin is a cancer survivor himself – he was diagnosed with testicular cancer in 2018 after noticing a lump.

Gamblin running outdoors

Gamblin has been working with a dietitian and a physical trainer to prepare for the seven-day marathon challenge. (Jan Gamblin, Ph.D.)

“I thought it was probably nothing, but I was really diligent about it and checked it out very quickly and discovered it was testicular cancer,” he explained. “And testicular cancer is the No. 1 cancer that affects males aged 15 to 45.”

One out of every 250 men will develop testicular cancer in their lifetime, according to the Testicular Cancer Awareness Foundation.

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“I went from being a cancer surgeon and giving all this advice, to having to take the advice I had been giving and apply it in my own life,” Gamblin noted. 

“The most intriguing one is the Antarctica race … it’s going to be such a unique environment and climate to run in.”

After going through chemotherapy and two operations, he has now been cancer-free for four years.

Gamblin’s desire to spread awareness has fueled the long and arduous training he has gone through to prepare for the 168-hour-long feat. 

Despite the challenges, he said he looks forward to the simple pleasures of the race, such as getting to know his fellow runners.

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Gamblin running at sunrise

Gamblin will run a marathon on every continent, including Antarctica, starting in January. (Jan Gamblin, Ph.D.)

“It’ll be such a unique group of people, too,” he said. “I’m prepared to make some lifetime friendships and hear other people’s stories.”

Gamblin is documenting his marathon journey through his Instagram account, @tclarkgamblin. He’s most excited about running through Antarctica.

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“So few people have run marathons there,” he said. “It’s going to be such a unique environment and climate to run in.”

In Miami, Gamblin will get to see his family at the finish line.

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Split image of Gamblin sitting, running

Gamblin said that he hopes his story encourages others to achieve their potential. (Jan Gamblin, Ph.D)

“I think that far too often, we don’t set our goals high enough in life,” the doctor said. “We don’t risk enough …This is a risk, it is a reach for me.”

The doctor said he aims to inspire other people to also set their sights higher than they normally would.

“Your body will in many cases do what the mind tells it to do,” Gamblin added. 

“And so I think we can challenge ourselves and push ourselves far beyond … the limits that we set.”

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Brush, floss, mouthwash: Dentists reveal what they believe is the correct order

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Brush, floss, mouthwash: Dentists reveal what they believe is the correct order

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Your dentist may remind you to brush, floss and mouthwash – but what is the “right” order to do it?

While all steps of oral hygiene can benefit dental health, Dr. Mike Wei, DDS, of New York City, shared with Fox News Digital that he’d recommend the below order.

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1. Floss

2. Brush

3. Mouthwash

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Starting with floss helps to remove food debris and plaque between the teeth and along the gumline, which a toothbrush “may not reach effectively,” according to Wei.

Dr. Ellie Phillips (not pictured) recommends using xylitol gum and mints to promote healthy salivary flow. (iStock)

“By flossing first, you can dislodge particles and bacteria from these tight spaces, making it easier for the toothbrush and mouthwash to clean the remaining surfaces of your teeth,” he said.

Next, brushing with a fluoride toothpaste can help remove plaque, bacteria and food particles from the surface of the teeth, the dentist advised.

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“By brushing after flossing, you are able to remove any particles that were loosened during flossing and ensure that all visible surfaces of your teeth are thoroughly cleaned,” Wei said.

Following up with an antimicrobial mouthwash can help further kill bacteria and reduce plaque buildup.

father daughter brushing teeth together

A dentist recommended using toothpaste with silica for proper exfoliation of the teeth.  (iStock)

Mouthwashing at the end can also help freshen the breath and reach areas that brushing or flossing may have missed, Wei noted.

“Overall, following this order of flossing, brushing and using mouthwash can help to ensure a comprehensive cleaning of your teeth and gums, leading to better oral hygiene and a reduced risk of dental issues, such as cavities and gum disease,” he said.

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WOMEN EXPERIENCE MORE DENTAL HEALTH ISSUES THAN MEN, EXPERTS SAY

This recommended sequence is common practice among dental professionals to achieve optimal oral health, including reduced risk of cavities and gum disease, Wei added.

Dr. Ellie Phillips, DDS, an oral health educator based in Austin, Texas, took it a step further, noting that a mouth rinse can act as a “cleanser” for the teeth before brushing.

person pours mouthwash into cup

Excessive use of mouthwash containing alcohol may lead to dry mouth and irritation, according to one expert. (iStock)

Rinsing with salt water or alternative mouthwashes like chlorine dioxide helps to remove any acidity from food and drink particles and prevent them from being brushed into the teeth, she told Fox News Digital.

For more Health articles, visit www.foxnews.com/health.

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After brushing with toothpaste and “massaging” the gums with a toothbrush to stimulate circulation, then it’s time to floss, Phillips said.

Flossing after brushing “will get toothpaste between your teeth,” she cautioned.

But the expert also warned that “a lot of floss contains PFAS chemicals,” which people should avoid pushing into their gums.

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After flossing, Phillips recommends rinsing with a traditional mouthwash, which studies have shown can be “five times more effective than flossing” just by swishing it through the teeth for a few seconds.

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man flossing his teeth in the bathroom

“A lot of floss contains PFAS chemical,” which people should avoid “pushing into their gums,” one dentist advised. (iStock)

Rinsing with water, especially with natural fluoride, at the end of an oral care routine can help absorb minerals into the teeth, according to Phillips, author of the upcoming second edition of her book “Kiss Your Dentist Goodbye.”

While there are “minimal risks” to basic oral care, Wei warned that excessive use of mouthwash containing alcohol could lead to dry mouth and irritation.

“It’s important to choose products recommended by dental professionals and follow instructions for proper use,” he said.

“Remember to consult with your dentist for personalized recommendations based on your oral health needs.”

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