I think this is interesting, and rather frightening.  Do we have any
comments? 
Mike 

Why is Our Government Pursuing a War on Doctors?
By David B. Brushwood, R.Ph., J.D.
We all make mistakes. We know we make mistakes. There's a wonderful phrase,
"The Fog of War." What the Fog of War means is that war is so complex it's
beyond the ability of the human mind to comprehend all the variables. Our
judgment, our understanding, are not adequate. And we kill people
unnecessarily.
Robert S. McNamara, Secretary of Defense, 1961-1968.
Ron Paul, M.D., a Republican United States Congressman from Texas, recently
declared on his website that "The War on Drugs is a War on Doctors." Dr.
Paul concludes that by applying federal statutes intended for drug dealers,
"prosecutors are waging a senseless war on doctors." The victims of this
war, says Dr. Paul, are not only doctors but also their untreated or under
treated patients in pain.
This conclusion is not news to anyone who has been keeping track of drug
enforcement activities over the past several years. It is certainly not news
to Dr. Frank Fisher, Pharmacist Stephen Miller, and Miller's wife Madeline
Miller. All three were charged with five counts of murder in alleged deaths
resulting from their prescribing and dispensing of opioid analgesics to pain
patients. All three have been exonerated. It is not news to over 100 other
doctors and pharmacists who have been charged with crimes for providing
opioid analgesics to pain patients. It is not news to chronic pain patients
who are living and dying in agony because doctors and pharmacists are afraid
to help them. It is not news to California Republican State Senator Sam
Aanstad, a dentist who has introduced legislation that would significantly
curtail the ability of prosecutors to charge doctors with crimes for
prescribing pain medications. It is not news to the news media, who have
finally recognized that the real story is the war on doctors and not the
diversion of opioids. Reporter Jen McCaffrey, of the Roanoke Times covered
the trial of Dr. Cecil Knox, who was acquitted of most charges but still
faces trial in a few remaining counts. She says that the joke among doctors
in Roanoke is "write a prescription, go to jail." This so-called "joke" is
not a bit funny. It is too true to be funny. 
Make no mistake. There is a war on doctors. There are tens of thousands of
innocent victims of this war. The war must be stopped. Dr. Ron Paul's
congressional colleagues should listen to him and act quickly.
Why is the war on doctors happening? Why is it happening now? Who is
responsible for this tragic injustice? What factors have brought us to this
intolerable situation from which an exit strategy must immediately be found?
Having studied the war on doctors for the past year, I believe there are at
least seven separate reasons for this war to happen and to happen now. I
base this conclusion on my study of documents from criminal cases against
doctors and pharmacists, and on public comments by both health care
professionals and drug enforcement authorities. These are the seven reasons:
1. The Pain Management Movement. Well intentioned advocacy groups have
championed the pain patient's right to relief of suffering. Doctors have
responded by increasing their prescribing of opioids to treat pain. But
standards for prescribing are unclear, especially for patients who are at
risk of aberrant medication behaviors, drug abuse, or addiction. Guidelines
for prescribing have been interpreted as standards, and standards are used
as a checklist of "gotchas" by law enforcement. No high volume prescriber
can practice without occasionally bending a rule because their patients are
all individuals with unique needs. The guidelines/standards/checklists are
useless in clinical practice, but they provide a clear roadmap for the
prosecution of a doctor for unlawful practice. 
2. The Rise of the Pain Management Specialist. Although there is
disagreement over who should be able to use the title "Pain Management
Specialist," it is evident that a small cadre of physicians have carved out
for themselves a new specialty in the treatment of chronic pain. Rightfully
proud of themselves and their achievements, some of these experts wrongly
criticize their generalist colleagues who treat pain because there are not
enough specialists to do this difficult job. Eager to accept hundreds of
dollars per hour reviewing generalist's records, some specialists criticize
the care provided by generalists and conclude that because it was not the
best quality care possible, it was criminal drug diversion. 
3. The Pharmacist as Informant. For decades pharmacists have been required
to distinguish legitimate prescriptions from forgeries. In the past ten
years, pharmacists have also been asked to evaluate the appropriateness of a
clearly legal prescription, through a process known as "Drug Use Review."
Many pharmacists do this job well and they improve the quality of patients'
lives while protecting the integrity of the nation's drug supply. Some
pharmacists, egged on by drug enforcement authorities, have misunderstood
their role as health care professionals and have become the enemy of
physicians and patients, reporting any out-of-the ordinary prescribing to
the police (without studying the issue or contacting the prescriber), then
basking in the camaraderie they enjoy with law enforcement (until they are
arrested for improper dispensing). 
4. Criminality in Health Care. A tiny few bad actors have tarnished the
reputation of health care professions. An English community physician has
admitted to euthanizing over 200 elderly patients. A New Jersey nurse has
admitted the same with about 40 hospitalized patients. A Kansas City
pharmacist deliberately diluted chemotherapy to increase his profits. Of
course, there is the widely publicized account of Jack Kevorkian and his
in-your-face challenges to law enforcement, shamelessly daring them to
prosecute him as he publicly killed one patient after another. These stories
lead some prosecutors to believe that local doctors may be psychopathic
Unabombers, gleefully poisoning the community with illicit drugs.
Compassionate care is easily confused with massive drug diversion when
investigators lose objectivity and find only what they have been taught to
find. 
5. Post 9-11 Security. These are threatening times. The government has
promised to protect the public from evil doers. But how can the government
protect the public from terrorists if it can't even provide protection from
drug diversion? The failed War on Drugs needs a success story and doctors
are available as safe targets. Unlike drug lords, doctors don't shoot back,
they naively think the legal system is consistently fair, and they don't
know how to find the best criminal lawyers. Doctors are sitting ducks. They
are being sacrificed to cover up massive failure by drug control
authorities. Prosecutions of doctors are used to assure the public that the
country is safe. 
6. Misled Media. Reporters have published stories critical of high opioid
prescribers, suggesting that irresponsible prescribing is the cause of drug
diversion. These stories are based on information obtained from sources that
support the war on doctors. The "facts" of these stores become the basis of
public opinion and of new legislation that restricts opioid prescribing or
penalizes those willing to prescribe. The truth is that prescribing is only
one of many channels through which drug diversion occurs. It is probably
only a small part of the problem. Employee theft, armed robbery, burglary,
truck hijacking, importation from other countries, and Internet sales are
responsible for a large amount of diverted pharmaceuticals. Shutting down
doctors won't solve this problem. 
7. Rising Drug Costs. To understand why the war on doctors is occurring, one
must follow the money. Taxes are currently viewed as a "burden" by most
lawmakers, who want to provide "relief" from this burden. Lower taxes have
reduced or flattened the budgets of state-managed Medicaid programs. There
isn't enough money to pay for the expensive drugs that poor people need.
High prescribers of any expensive drug risk criticism and must overcome
administrative barriers due to their prescribing habits. High prescribers of
expensive opioid analgesics are labeled as drug traffickers and they are put
out of business. It is a way to balance the budget. This problem will only
get worse when the poorly designed and under funded Medicare prescription
drug program begins. 
. Robert McNamara advises: "Empathize with your adversary or risk the kind
of miscalculation, misperception, and misjudgment that, among Great Powers,
can lead to catastrophic war." The government's war on doctors lacks
empathy. Those who pursue it should follow McNamara's advice. They should
put themselves in the skin of doctors who treat chronic pain and look
through these eyes at patients who suffer. They will see a disheartened,
poor, cynical, out-of-work lot. They will also see tremendous opportunities
to transform lives by providing safe and effective medications. Only then
will they understand the thoughts that lie behind the decisions and actions
of doctors who treat chronic pain. The war on doctors cannot be won because
it is an unjust war. Too many people experience chronic pain themselves or
know and love others who do. If it continues, this war will eventually be
lost, but not without unnecessary suffering and death. The war on doctors
must be stopped now !

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