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AN URGENT PLEA TO END THE WAR AGAINST PHYSICIANS AND PATIENTS

UPDATE 12/5/17:  A revised (shorter)version of this blog has been posted in KevinMD, at the following location.  Thanks, KevinMD!

https://www.kevinmd.com/blog/2017/12/stop-opioid-crisis-war-physicians-must-end.html

 

 

Crimes against humanity are widespread on this planet, and too many to count.  Over the past decade diligent researchers (by diligent I mean those who verify sources and results) have uncovered the roots of some of our more persistent and frightening social problems, and published reputable accounts thereof.  Many such problems are actually the result of conspiracies set decades ago, like the rise of private prisons for the purpose of incarcerating a specific race of young people because of socioeconomic issues (read racism), and calling it a War Against Drugs.  But the drugs continued to take over our nation—not just because of those young people, but because of the greed for money and power in the pharmaceutical companies, insurance companies, and politicians that has grown exponentially, unchecked.  Nixon’s intended outcome—that of getting minorities off the streets and severely impacting their ability to live normal lives outside of prison—also suited well the baser needs of other groups in our society.

Other groups, in fact, began to see the financial success and knowledge of physicians to be a major threat to their own greedy plans.  They deduced that chronic pain patients, now acknowledged and receiving treatment for their pain, could be both blamed as a source of street drugs and used to help bring down honest physicians (and to support the pill mill “doctors” who supplied the patients with enough medicine  to both use and sell).  Eventually, we begin to see “statistical reports” that “prescription drugs” were the cause of abuse and overdose deaths in specific regions of our country.   For a short time, they may have been.  But when the deaths began to occur in White Middle-Class families, the outcry to increase the efforts of the War on Drugs became deafening.  There had to appear to be some effort to control the drugs, so we see draconian measures being set—in some states by law, in others by regulation—that were targeting the legitimate physicians who prescribed for pain patients, and ultimately the patients who were frequently cut off without warning from their pain treatment.  Despite the outcry against punishing patients and physicians, and the evidence showing the futility of this approach to the War on Drugs, this situation continues to threaten the lives of both patients and their physicians, every day.

Despite scientific proof that Substance Abuse Disorder (being addicted to a substance) is an illness of the brain and can usually be well managed by an addiction specialist, legislators and law enforcement officials alike still only see “drunks and addicts” and still, after DECADES of failure, claim that incarceration/punishment is the only way to fight the war on drugs.

Despite, also, the logic that if you are fighting a War against a crime, you go after the source rather than innocent bystanders.  If we don’t get rid of the sources:  drug cartels, the dealers, and the creators of the drug,  how much good is it going to do to punish the people who use them?  Sadly, these sources have never been the primary targets.  Just as now we see heroin and fentanyl actually being the greater cause of overdose deaths (because they are cheap and much more potent than earlier versions), we still hear and see stories about prescription drugs being the cause of these deaths.  We are still subjected to so-called charts describing dubious statistical proof that prescription drugs are the main cause of overdoses, when more reliable research shows that it is street heroin and fentanyl.

To that, I would ask the reader to please follow the hyperlink below.  The author of this piece has provided a thoughtful and well researched discussion of what is really causing overdose deaths, and why the propaganda we are getting is so dishonest:

https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935

Having read this article, consider well the facts that every year more than 400 physicians commit suicide;  that thousands of chronic pain patients suddenly deprived of their medication have either committed suicide or gone to the streets to get their medication; and that many of these have also suffered unintended overdose deaths.

These measures that make practicing good medicine so difficult, and the law enforcement mentality that believes physicians are guilty until proven innocent,  are not the only reasons physicians are either opting out of practicing medicine, or opting out of life altogether.  The War on Physicians and on Patients is real, and it is devastating.  The pharmaceutical houses and insurance companies may actually believe that we can survive without trained doctors; Artificial Intelligence will be just as good if not better, they believe….but check out this article:

https://www.scientificamerican.com/article/the-social-life-of-opioids/.

We read here that there is well-researched, scientific proof that a caring and trusting relationship between patient and doctor is a necessary, (but not sufficient), ingredient for best medical practice—AND for healing!  As one incredible physician has noted:  “They (the patients) don’t care how much you know until they know how much you care.”  Artificial intelligence hasn’t managed the caring part, and even if it does I don’t see much healing effect to be expected from a robotic hug.

The crime against pain patients who are now not only being vilified in news media, in pharmacies, and in social media, is certainly heartbreaking.  If you happen to be one of those pain patients, it is also a return to the terrors of intractable pain, inability to function productively in society, and a potentially horrible death.

If you are a physician who has spent at least half the normal human life span studying and preparing to make life better for those who suffer, life may be  becoming a nightmare.  Insurance companies dictate what treatments are allowable, how often, and how long such treatments will be permitted.  They do not refer to medical societies for their information.  They refer to bottom line profit indexes.  Legislators who pass laws (when medical board regulations would more properly suffice) that limit what physicians can prescribe, and how often—arrange that physician’s offices and lives will be disrupted, the physicians in question treated as guilty before having a chance to be proven innocent.  As usual, those who are charged with the felonies that have been put in place as a weapon in the War on Drugs never quite regain their previous status of innocence, even when proven so.

Does it matter to the insurance companies or the legislators that these laws have only created chaos and confusion, betrayal and mistrust?  Does it matter that physicians are already reeling from finding themselves backed into corners where they have to “sign on” to corporate health care entities that are run by non-medical administrators who decree when and how often they work, how many patients they will see for how long, and determine bonuses based on computer-run quotas and outcomes?  Does it matter that medical students are so disillusioned that they drop out, and that some commit suicide?

And finally, adding to the fears of losing their practices, their licenses, and the meaning attached to their life work, physicians in increasing numbers are being attacked and/or killed by frustrated, angry patients or their relatives.

Why is this ethically, morally, and even logically wrong approach to our drug crisis—which MUST be separated in our minds from medical care for chronic pain patients—continuing to exist as a modus operandi?  Why are physicians who serve our communities targeted as criminals at worst, and problem employees who must be managed at best?  Sociologically, physicians have historically belonged to one of the highest prestige vocations in America.  Their demotion to the present state is not through fault of their own, but through others’ sociopathic greed for money and power, combined with the attitude that allows so many to hate anyone who differs from themselves, to create this totally inhumane situation.

It is not “liberal” or “progressive” to respect and care for others.  It is Christian, and Muslim, and Hindi, and Jewish—it is a basic precept of many world religions and predates organized religion itself by centuries.  Of course, being human and egocentric, we do not always succeed in living up to these standards.

It is my opinion that the proof of our own individual humanity is the maturity, intelligence and self-motivation to care for others as we care for ourselves.

I could go on for pages about why so many people have lost the human characteristic of empathy, but there are enough people who retain it who could help our country become human again.  Who still respect the dignity of other human life, and who realize that “together, we stand; divided, we fall.”

It is definitely in our best interests to respect and protect the lives and experience of our physicians; it is also in our best interests not to stand by and leave them or their patients to live and die in misery when it is all so unnecessary.  And inhuman.

And, a last plea……

 

 

RESOURCES:

Alexander, Michelle.  The New Jim Crow:  Mass Incarceration in the Age of Colorblindness.  2012.  The New Press, NY

Bertram, Eva and Morrris Blachman. Drug War Politics: The Price of Denial.  1996. University of California Press.

Bateman, Dustin.  Neurobiological & Sociological Aspects of Addiction

Levinthal, Charles F.  Messengers of Paradise.  Opiates and the Brain.  The Struggle Over Pain, Rage, Uncertainty and Addiction. 

Meier, Barry.  A World of Hurt:  Fixing Pain Medicine’s Biggest Mistake.  2013.  New York Times Company.

Parsons, Talcott.  “Illness and the Role of the Physician:  A Sociological Perspective.”  American Journal of Orthopsychiatry 24 March 2010.  Copyright © 2010, John Wiley and Sons.

Quinones, Sam.  Dreamland:  The True Tale of America’s Opiate Epidemic.  2015.  Bloomsbury Publishing Plc.

Sternheimer, Karen.  Connecting Social Problems and Popular Culture:   Why Media is not the Answer. 2nd Ed.  2013.  Westview Press, Perseus Books Group.

Webster, Lynn R.  The Painful Truth:  What Chronic Pain is Really Like and What it Means to Each of Us.  2015.  Webster Media LLC, PO Box 581113, Salt Lake City UT 84158.

WEB ARTICLES, including peer reviewed

Pain Medicine News – How Did We Get Here? http://www.painmedicinenews.com/ViewArticle.aspx?d=Guest%2BEditorial&d_id=351&i=March+2014&i_id=1042&a_id=26043&tab=MostEmailed#.U3PLVV6vdyI.twitter

Report: Chronic, Undertreated Pain Affects 116 Million Americans http://ti.me/AAfT7q  via @TIMEHealth

New Pain Management Rules Leave Patients Hurting http://seattletimes.com/html/localnews/2016035307_pain28m.html#.U2mA77bwJzQ.twitter

Chronic Undertreated pain affects 116 million Americans: http://healthland.time.com/2011/06/29/report-chronic-undertreated-pain-affects-116-million-americans/

Our Fear of Opioids Leaves the world in Pain  http://edsinfo.wordpress.com/2014/10/27/our-fear-of-opioids-leaves-the-world-in-pain/

MT @toni_bernhard: My new piece. It should be of interest to anyone whose illness is questioned: http://www.psychologytoday.com/blog/turning-straw-gold/201410/i-m-sick-what-is-wrong-me …Dr. Paul Christo @DrPaulChristo  ·  Oct 27

California Doctor….    http://paindr.com/california-doctor-unveils-painful-abyss-facing-patients-in-pain/

Physician Suicide:  http://t.co/4vhF63eD6N

Physician Risks:

The damage done by the war on opioids: the pendulum has swung too far http://www.dovepress.com/articles.php?article_id=16781 …

Trial Verdict:  Dr. Baldi Not Guilty on All Charges http://whotv.com/2014/05/01/baldi-trial-not-guilty-on-all-charges/

What are Patients to do when Law Enforcement Closes Clinics?  http://missoulian.com/news/state-and-regional/ravalli-county-health-officer-says-patients-of-raided-florence-clinic/article_cf2e1690-bac0-11e3-848e-001a4bcf887a.html

Killing Pain in Perry county http://www.kentucky.com/2009/12/12/1056711/killing-pain-in-perry-co.html

Patient role in helping physicians:

“Unless patients wake up and fight for the providers of care, we are headed for the sickest system in the world.” http://www.kevinmd.com/blog/2014/03/dissatisfied-doctors-provide-good-patient-care.html …


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THE ELECTION IS HANGING IN THE BALANCE

I am what one could call “an elder.” My station in life affords me the ability, or perhaps burden, to look back and assess the arc of history’s swinging pendulum. I’ve seen this play before. I didn’t like it then and I don’t like it now.

It’s only August, and only midterm elections, but already the advertisements have been repeated so often for so long that I can lip sync with them. At least the primaries held some interest, with more candidates to listen to and select from. Now we are down to a predictable routine: “He doesn’t do” this or that job, to which the answer is always “HE LIES!” It was a lot more interesting when I was teaching, and we had debates based on research of actual records, and mock elections. Grades were given based on points won while sticking to the facts, and class discussions were even more heated than the TV versions. No wonder I’m bored with it now.

Every two years since my return from South Africa, I am reminded of a conversation with one of my dear friends as we sat up through the night awaiting the results of the presidential election of 1992. I am always impressed with how very politically informed about the world people in other countries are, compared to Americans, and this day was no exception. “You know,” she began wistfully, “I wish so very much that when our national elections are held democratically we could be as civilized about the results as Americans are.”

“How so?” I was intrigued. Aileen, more intelligent than most people I knew, was bound to have a profound insight on this subject. “Because, even though this election is a fierce battle between your political parties, once the election is over you all will settle down, accept the winner, and once again pull together for the good of the country. Because you love your democracy so much, and you really believe in it. And that is why it works.”

And I believed her. Because her words corroborated my experience, up to that time. Sure, I had lived through the whole Watergate saga, as well as Contra-Gate. But we survived all that, didn’t we? I was never more proud to be an American than I was that night, seeing my country, and democracy, through the eyes of this remarkable Afrikaans woman.

Then, early 1996, I was home again. Or at least I thought that was where I had come. Eyes wide with astonishment, mouth agape, day after day I watched my elected representatives behaving like maladjusted toddlers not just in public, but on national TV.   I had never seen such infantile behavior by political leadership, including the entire seven years I spent in Africa. In Africa, political disagreements were life threatening more often than not; in America they sounded life threatening even though they were far from such extreme issues. In 1996, I witnessed for the first time the failure of my fellow Americans to graciously accept the working of the democratic process. Rather than accept, they hated it so much, in fact, that the losing party seemed to wish the leadership of the winning party dead. From the noise, it sounded like nothing else would satisfy them.

By 2000, I was already comparing the good ol’ USA to apartheid South Africa. It was getting more like the old RSA every day, to my understanding. People no longer identified themselves by ethnicity, vocation or religion. They “became” a Republican, or a Democrat, so that in much the same way as we used to say “I’m a plumber,” or “I’m Baptist,” what had begun as a personal option had become an entire identity.

What I found so alarming about this was that in South Africa I lived in the middle of a revolution, where people died, sometimes as innocent bystanders, but always because of a political identity. The anger I felt and witnessed here was just as deep, just as mindless, as what I saw in South Africa – despite the absence of war and terrorism. Then, in September of 2001, we had terrorism. For all too brief a time, we were Americans, together, again. Then we had the Patriot Act, and the War, and Homeland Security. It was the latter, despite all the protected rights that we lost permanently with the Patriot Act, that spelled out “South Africa” for me in huge letters.

Of all the names they could have given that agency, they picked Homeland Security. The name of the most abusive agency in South Africa, the agency that could do whatever it wished to any person, and justify it under the name of Homeland Security. Forget your rights, if Homeland Security considered you any kind of threat to South Africa. Now I live, again, in a country where I say the same thing about an agency with the same name and mission.

In apartheid South Africa, the poor were disenfranchised and abused by the wealthy. And so, it seems, they will be in America. Politics in South Africa were corrupt. People hated other people for being different, and it was enough to kill them for. The wealthy, to protect themselves, lived in walled compounds with security guards – actually prisoners in their own homes.   I often longed for the freedom of a small town neighborhood in America, where I could take a walk by myself late in the evening, or sleep with my windows open. Now, locking my door here in America is such a habit that I keep locking myself out when I go to get the mail.

Finally, in South Africa the architects of apartheid (pronounced, appropriately, “apart – hate”) based their political stand on their religious belief that the Bible clearly stated that the races should not intermarry. Like many such interpretations, even if true, it is hardly enough to merit committing murder. Especially if you are able to ignore virtually dozens of other “thou shalt nots” without turning a hair. They also subscribed to the belief that they were the chosen people of God, who had given them South Africa for their own, and their political wealth and power to prove His point. Take the race issues out of the question and look at the scene in socioeconomic colors, and the parallels with America today become really depressing.

In the end, South Africa also learned that you can’t legislate morality.   America has forgotten that truth.

I am certain that in every generation there are the elders, looking back with saddened eyes and faces, mourning the country that they once knew. Today, I am one of those. The pendulum of history has swung too far since the craziness of the 60s, and a swing back to the opposite point again is inevitable. I just hope to live to see it hesitate, for a little while, in the balance of moderation.