Death from painful medical myths

http://www.NewsAndOpinion.com | Pain makes people miserable, unproductive, depressed and worse. And not only patients feel badly. The doctors who dare prescribe pain medications are now risking their careers - because at any moment government prosecutors may decide to target their practices.

The government permits doctors a zero percent error rate in prescribing medicines. No mistakes allowed. Even one prescription judged unlawful can lead to a conviction that labels the doctor a felon, and triggers other laws resulting in loss of medical license and the ability to make a living as a physician.

Compare this zero tolerance with the much more lenient policy applied to insurance companies under contract to process Medicare claims. For these companies, the government allows a seven percent error rate.

In the past, we've described how over-zealous government agents target doctors. But behind this zeal are other factors.

One is the prohibitionist attitude towards some pain-killing medicines, such as morphine and other opiates. Until the 1920s, narcotics users were under medical treatment or largely ignored by government agents. However, Congress created a Narcotics Division of the Treasury Department which succeeded in creating a very large criminal class for itself to police, but has not "solved" the narcotics problem to this day.

Another factor is that pain management is a judgment call; there are no objective tests to measure pain.

Yet another is the remarkable advances in pain-relief medications that have become available over the past decade. In the 1990s, new drug forms such as Duragesic and Oxy-Contin markedly advanced the art and science of pain treatment. They do not cure the condition causing pain. Patients often become dependent on these drugs just as people taking replacement thyroid hormones become dependent. Note well: the patients are not "legally" addicted, according to the definition below. They are dependent, meaning the patient requires the medicine to ameliorate the pain and get on with life just as some patients require replacement thyroid hormone to function normally.

The Drug Enforcement Administration (DEA) defines addicts as "individuals who habitually use any narcotic drug that endangers the public morals, health, safety, or welfare" [21 USC Sec. 802 (1)]. This leads some to the mistaken belief that chronic non-cancerous pain patients taking large amounts of legally-prescribed narcotics are addicts and that physicians who treat them are conspirators in the illegal drug trade. This ignores the medical fact that less than one percent of chronic pain patients are addicted in this sense.

However, the DEA takes the non-medical and non-scientific position that narcotics such as OxyContin should be the medicine of "last resort for chronic pain," disregarding the dangers of other non-narcotic and less-effective medicines. Obviously, determining whether a pain patient is also an "addict" and whether OxyContin is "medically necessary" in treating chronic pain is clearly beyond the ability of DEA agents who are rarely physicians and who never actually have a patient-doctor relationship with the people they accuse of being addicts.

A drug addict seeking new thrills or transitory highs is a very different person from a patient whose chronic pain is relieved by pain medicines.

Unfortunately, the police and news media often conflate the two categories. The drug police get reports of pain medicine prescriptions from pharmacies. They investigate, arrest and prosecute doctors prescribing what these police think is too much of these medicines. Other doctors hear about these arrests and understandably become more reluctant to prescribe the doses many patients need.

Says Dr. Jane Orient, Clinical Lecturer in Internal Medicine at the University of Arizona College of Medicine and Executive Director of the Association of American Physicians and Surgeons "The needs of patients, and the need of society to combat the social pathology of substance abuse, can be met only if physicians are treated by law enforcement as allies rather than adversaries, and the rights of both patients and physicians are respected. Zero tolerance for error will result in zero access to desperately needed treatment for many patients."

Fortunately, patients and physicians are organizing to combat these misinterpretations of law and medical practice. They are presenting model policy and legislative proposals to policymakers around the country, including Washington DC, with positive changes already enacted in many states.

In pain treatment, half a loaf can be as bad as no loaf at all; inadequate treatment leaves the patient still suffering. Too many people are paying a painful price because their doctors rightly fear being charged with a crime for helping them.

Maybe people in chronic pain should go directly to vice squad agents for medical services - since they've taken on the ultimate responsibility for determining what's "medically necessary".

Editor's Note: Robert J. Cihak wrote this week's column.

Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute Senior Fellow and a past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here.

05/07/04: Fear in the Medical Garden of Eden
04/30/04: DDT vs. Death by Malaria
04/23/04: In pain do we part!
04/16/04: Free — or not free — to treat pain
04/09/04: Wrong Military Diagnoses & Treatments
04/02/04: Radiation monster slain
03/19/04: What Do — and Don't — Bush and Kerry Plan to do to Your Health Choices
03/15/04: Dear Rush: We Feel Your Pain, So Now Feel the Pain of Others
03/05/04: Fraudulent use of fraud laws — by government
02/27/04: Population growth, birth control and increased terrorism?
02/20/04: Doctors fighting against doctors, at the behest of the government and lawyers
02/13/04: Legal Cancer in the White House?
02/06/04: Feds Harass Doctors. Who's Next?
01/30/04: Women, the Military and Medical Misconceptions
01/23/04: Welfare for the Wealthy
01/19/04: New diagnoses and strategies create both short and long term problems for medicine and the military
01/09/04: A new plastic phobia?
01/02/04: Baseball Good Medicine?: International Forkball and Split Finger Rotating Our Way Soon
12/26/03: Medicare Bankrupt: A Possible Palliative 12/19/03: Crossing Fruit Street: Some Movies Like "Stuck on You" Cross the Medical Line
12/12/03: Silver Lining in the Medicare Clouds?
12/05/03: Medicare mop up
12/01/03: The Dirty Radioactive Bomb: Rational Response or Fear Itself?
11/24/03: The Caduceus Conspiracy: How the People Lost Medicine and How We Can Take It Back
11/14/03: Mosquitoes kill us; DDT doesn't
11/07/03: Avoiding the Schiavo Scenario: Readers Speak Out With Life-and-Death Comments
10/31/03: The Terri Schindler-Schiavo Case: Speaking out for those who can't
10/24/03: Want health service — go on a diet?
10/15/03: The War on Legal Painkillers: Sen. Kerry owes an apology to the more than 48 million Americans who suffer chronic pain
10/13/03: Medicare defrauds itself
09/19/03: Politics prevents women from learning about abortion/breast cancer risks
09/12/03: Medical mischief
09/05/03: Unholy medicine
08/29/03: The California Tea Party and West Coast Determinism; Voter anger coming your way soon
08/18/03: The outlaw prosecutors: A Justice and Civil Liberties Issue
08/08/03: "Toxic Teeth?"
07/25/03: Resuscitating the Constitution; CPR American Style
07/25/03: Drug reimportation: Bill translates to goodnight, patients
07/11/03: Costly Medicare Changes, Without Real Reform
07/04/03: The Painful DEA II: War on legal drugs ensnares too many doctors and not enough dealers
06/20/03: The Medicare Mess: Will President Bush call Congress' Bluff?
06/13/03: Diagnosis: School Insanity: A suit for sanity and school discipline
06/05/03: Soaring Medical Costs: Rational ignorance or rational enlightenment?
05/30/03: A Tale of Two Admirable Women: Jessica and Annika
05/23/03: Latest medical innovation: Cash
05/09/03: We feel your pain; Physicians have it too no thanks to the DEA
05/02/03: Medical Quarterbacking
04/25/03: CNN the "Conscience-Not Network"
04/21/03: Medical Miranda?
04/11/03: Are childhood vaccines shots in the dark?
04/09/03: The PETA Principle -- The lambshank Redemption
03/28/03: American conscience?
03/21/03: West Wimps or Wings: Treatment for Hollywood Hypocrisy
03/13/03: Worldwide schmaltz shortage looms --- all because of a featherless chicken
03/06/03: Legal metastases are killing us
02/28/03: Outside the Jury Box: Seeking Justice rather than a Lottery in Medical Liability
02/21/03: Workforce temperature rising; employer TLC in demand
02/14/03: Malpractice Insurance: They Reap What They Sue
02/12/03: Hawk, Dove or Groundhog: Diagnosis Critical List; Prognosis Uncertain
02/07/03: How about tax cuts for the "rich" and "poor"?
01/31/03: AIDS Bug Chasers
01/24/03: Libertarian moment or movement?
01/17/03: It's not just 'sue the docs' anymore
01/03/03: A pox on the critics; diagnosis sour grapes
01/03/03: If protesting is good for your health; then at least let's root for the home team
12/20/02: Obesidemic (obesity epidemic) or not?
12/20/02: Time for voluntary informed smallpox vaccinations
12/13/02: The real reason the state opposes homeschooling?
12/06/02: Conscience of a former conservative: Portrait of a political metamorphosis
11/27/02: Thanksgiving dinner hazard?
11/22/02: Time to think outside the box and inside the nucleus
11/15/02: The military should be protected from abusive environmental laws in times of war
11/11/02: Does Kyoto Treaty pose more harm than global warming?
10/31/02: Deep thoughts on Baseball, the World Series and Life: How about them Anaheim Angels?
10/23/02: "Pediatric rule" guinea pigs
10/23/02: Once the World Series ends, we need to create a Donnie Moore Day of Remembrance: Sports and mental health
10/18/02: Congress to senior patients: Do as we say not as we do for ourselves
10/11/02: Using pollution "scare labeling" to political advantage
10/04/02: The Great Asbestos Heist: Did Litigation and Junk Medical Science Helped Bring Down the World Trade Center?
09/27/02: The imminent rise of civic feminism: A far healthier national alternative in war and peace
09/20/02: A Ray A Day" to replace the daily apple?
09/13/02: Beware of celebrities hawking drugs
09/06/02: Avoid 9/11 overdose: Give blood to begin "September of Service," SOS
08/28/02: From Doubleday to strikeday: Baseball's collective anxiety attack
08/23/02: Should she or shouldn't she?: An alternative view on treating menopause with HRT
08/16/02: Cooking up defenses against germ warfare
08/02/02: Medicine, crime and canines
07/26/02: Lies, pathologic lies and the Palestinians
07/19/02: Medicare Drug Follies � as in "now you see it, now you don't"
07/12/02: Anti-Profiling: A New Medically False Belief System
07/08/02: Don't procrastinate, vaccinate!
06/28/02: The scientific advances on the safe and effective deployment of DDT are being ignored, or denied. Why?
06/21/02: Sex and the system: In seeking healthcare men are different from women
06/14/02: The FDA, drug companies and life-saving drugs: Who's the fox and who's the hen now?
06/07/02: Medical Privacy Lost: A hippo on the healthcare back!
05/24/02: To clean up America's game: A (soggy) ground rule
05/10/02: Free speech is good medicine
05/03/02: Medicine's Vietnam
04/26/02: Attack on alternative medicine could lead to alternative lawsuits
04/12/02: Insure the 'crazies'?
04/09/02: No Time for Litmus Tests: In War We Need a Surgeon General and NIH, CDC, and FDA Directors
04/02/02: The scoop on soot: A dirty rotten shame?
03/22/02: Too many beautiful minds to waste: The first annual Caduceus Movie
03/15/02: Terror and transformation: Defense essential for health & state of mind
03/08/02: Diagnosis: Delusional
03/06/02: The great matzah famine
03/01/02: Is new Hippocratic Oath hypocritical?
02/15/02: Why the recent moaning about cloning?
02/08/02: Searching for Dr. Strangelove
01/15/02: Score one for the value of human life
01/04/02: Medical-legal-financial wake-up call
12/28/01: Who's afraid of a 'dirty bomb'?
12/21/01: End of medicine?
12/14/01: More heroes: Docs deserve a little credit after 9/11
11/16/01: Do we need 'Super Smallpox Saturdays'?
11/09/01: Why the post-9-11 health care debate will never be the same
11/01/01: Common sense good for our mental health
10/26/01: Your right to medical privacy --- even in terror time
10/12/01: Failed immigration policy ultimately bad for nation's mental health: Enemy within leads to epidemic of jumpy nerves
09/28/01: Can legal leopards change their spots: A treat instead of a trick
09/21/01: Civil defense again a civic duty
08/30/01: Shut down this government CAFE
08/23/01: School Bells or Jail Cells?
08/15/01: Time to take coaches to the woodshed
08/10/01: Blood, Guts & Glory: The Stem of the Stem Cell controversy