Jewish World Review May 9, 2003 / 7 Iyar, 5763
Drs. Michael A. Glueck & Robert J. Cihak
We feel your pain; Physicians have it too no thanks to the DEA
Everybody knows what a "symptom" is. It's an indicator of something else.
Some symptoms, such as a runny nose, can indicate something as trivial as a
head cold. Other symptoms point to far more debilitating or even deadly
This article is about the Drug Enforcement Administration (DEA) inflicting
pain on both patients and doctors - and what this symptom might mean.
Way back during the so-called Progressive Era a century ago, a de facto
alliance of physicians and bureaucrats undertook to regulate the possession
and distribution of drugs, especially those that affected the sensation of
pain. Their intentions like those of the temperance movement were humane, at
least in theory. They had seen what morphine addiction had done to a
generation of Civil War veterans; they'd watched too many middle-class
matrons quietly wasting away on laudanum, an opium preparation. They wanted
Whether they did or not help is debated to this day. But never could the
most ardent Progressive do-gooder have imagined that today, anti-drug laws
would be used by overzealous bureaucrats and frenetic enforcers to deny
patients desperately needed treatments, or drive physicians out of medical
practice, or send them to prison.
No, we're not talking here about legalizing marijuana, or about the tiny
percentage of doctors who criminally abuse their prescription pads, and
belong in jail. We're talking about government agents making it ever more
difficult for patients in severe pain to get relief, as these government
officials take unto themselves the "responsibility" of keeping patients from
becoming "addicted" to drugs that allay their suffering and survive.
Publicly, the Feds make all the right noises. Asa Hutchinson, former DEA
Director, speaking to a meeting of the American Pain Society on March 14,
2002, told doctors:
"...we trust your judgment. You know your patients. The DEA does not intend
to play the role of doctor. Only a physician has the information and
knowledge necessary to decide what is appropriate for the management of pain
in a particular situation. The DEA is not here to dictate that to you. ....
We never want to deny deserving patients access to drugs that relieve
suffering and improve the quality of life."
But consider what the drug enforcers actually do:
- Dr. Deborah Bordeaux of South Carolina was convicted under a "drug
kingpin" statute carrying a mandatory minimum sentence of 20 years, even
though she'd worked only two months in a temporary position treating chronic
pain and other ailments.
- The late Dr. Benjamin Moore, worked briefly in the same clinic, pled
guilty although convinced of his own innocence, and then committed suicide
rather than testify against others.
- Dr. Jeri Hassman of Arizona, who had the largest pain practice in Tucson,
is being threatened with a 28-year prison term, apparently because a small
fraction of her patients used prescriptions in unauthorized ways.
Mere anecdotes? Perhaps. But then, the plural of "anecdote" is "data." And
there are many, many more examples.
Other government actions "send the same message." At a pain management
conference sponsored by the Pima County Medical Society of Tucson, Arizona,
speakers such as David Greenberg, MD, MPH, chief investigator for Arizona
Medical Board, and Neil Irick, MD, a pain specialist from Bloomington,
Indiana, told doctors to protect themselves by using surveillance cameras
and urine drug screens to make sure each patient is as "clean" as he or she
claims to be. Further, to make sure the patient isn't importing somebody
else's clean urine, they advised doctors to frisk patients before they give
the urine specimen, and then to maintain a chain of custody for the
specimen, the same way police treat specimens from criminal drug suspects.
In other words, doctors should consider their patients to be criminal
suspects, until proven innocent.
The Association of American Physicians and Surgeons (AAPS) is now warning
doctors to avoid medicines out of favor by DEA officials and to avoid
prescribing more medicine than the DEA finds "usual" lest more doctors
suffer similar, painful fates.
Again, we're not talking here about street drugs. We're talking about
doctors prescribing legal drugs to patients who may not be able to survive,
let alone function, without them. For example, some patients with cancer
pain lose their appetite and can't keep food down; without adequate and
appropriate treatment for the pain, these people starve to death and die
quickly. But with adequate treatment, many of these same people regain their
appetite and strength, and live for many years.
And as the "guilty until proven innocent" standard comes to apply to doctors
as well as patients, more and more physicians begin to practice that
ultimate form of "defensive medicine" - quitting their pain management
practice or getting out of medicine entirely.
But the problem goes much deeper than out-of-control drug cops. The
government is relentlessly forcing the American physician to become the
servant of the state, as hyper-regulated care-giver and as on-call
policeman, under constant threat of criminal prosecution.
As usual, we recommend you write the president, senators and representatives
in Congress and tell them to stop treating doctors as criminals.
Now, given these symptoms, ask yourself . . . "Where does it hurt?"
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Michael Arnold Glueck, M.D., is a multiple award winning writer who
comments on medical- legal issues. Robert J. Cihak, M.D., is past
president of the Association of American Physicians and Surgeons.
JWR contributors are Harvard trained diagnostic radiologists.
Comment by clicking here.
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