Friday, March 30, 2007

Pain doc vs. the pleasure police

Whichever side you fall on in the debate over the "war on drugs," there's a subset of America's continuing experiment with Prohibition that really should have everybody unified in horror. As part of its efforts to make sure that nobody takes unapproved intoxicants, the government has waged an ongoing campaign against doctors who use powerful medications to control pain in often-terminal patients. By their very nature, these drugs can also be used recreationally, causing the pleasure-police to suspect every prescription as a fake and every doctor as a pusher. The current poster-child for physicians on the receiving end of the government's puritanical wrath is Dr. William Hurwitz, whose retrial began this week in Alexandria, Virginia.

John Tierney of The New York Times has been covering the case, and covering it well. If you're late to the story, Tierney has an excellent roundup of the situation in his Findings column.

Hurwitz is being tried a second time because the jury the first time around was improperly instructed to ignore whether Dr. Hurwitz had acted in “good faith.” That first jury convicted Hurwitz, sending him to prison allegedly for trafficking in narcotics under cover of medicine. A review of the trial shows that Hurwitz was railroaded by a litany of misrepresentations and junk science. As Tierney points out:

During the first trial, the prosecution argued that it was beyond the “bounds of medicine” for Dr. Hurwitz to prescribe more than 195 milligrams of morphine per day, but dosages more than 60 times that level are considered acceptable in a medical textbook. The prosecution’s supposedly expert testimony on dosage levels and proper pain treatment for drug addicts was called “factually wrong” and “without foundation in the medical literature” in a joint statement by Dr. Russell K. Portenoy and five other past presidents of the American Pain Society.

Tierney reports on his blog that the new trial is already starting off with a better presentation by the defense team. His initial post on the proceedings is here.

With luck -- and good lawyering -- Hurwitz will go free this time. That will be an important signal to doctors and patients that DEA agents won't be freely second-guessing medical decisions.

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