Cultural Baggage 8/10/04
Hosted by Dean Becker
Engineered by Steve Nolin
Transcript by Philip Guffy
Guests: Dr. Joel Hochman, founder and executive director of the National Foundation for the treatment of pain. http://www.paincare.org
Dr. Stratton Hill, professor emeritus of medicine, pioneered new pain treatment at M. D. Anderson hospital.
(Audio Track) Intro and Poppygate – Glenn Greenway: Bush administration officials have indicated that Afghanistan's opium production in 2004 will be nearly double that of 2003 and will double again by 2005. Time magazine reports in this week's edition that conservative estimates indicate that al-Qaeda and the Taliban are earning tens of millions of dollars from Afghan opium. PBS reported last week that seven million Afghanis now rely on Poppy farming for their livelihoods. Last Sunday the New York Times reported that Twenty-one U.S. troops have died from ambushes, land mines and other hostile fire in Afghanistan so far this year, compared with 12 combat deaths in all of 2003. Wrapping up today's Poppygate update: Afghan Opium production and US combat deaths in Afghanistan will double this year. Seven million Afghanis now rely on Poppy farming and al-Qaeda is making millions from the Opium trade. This is Glenn Greenway reporting for the Drug Truth Network.
Dean: Well I feel privileged that the caliber of the guests willing to come on this show just keeps on keeping on. I started three years ago, broadcasting from the gulag city, that this drug war is a sham. Our guests range form judges to scientists, from warden to prisoner, all proclaiming the drug war a failure, a hopeless failure. Powerful words spoken by U.S. congressmen, Canadian senators, Nobel Prize winners and members of the European parliament in support of this host and the Drug Truth Network have helped tremendously in the growth of our little network of broadcast affiliates. Yet, feigned ignorance still thrives in certain offices of government and superstition lives on in the populace, but the truth is evident, and the failure of the drug war grows more obvious with each passing day. Most of all, the progress comes from you, my dear listeners. Through your support and involvement in working to end the harms of the drug war, the Drug Truth Network keeps on keeping on as well. Starting this week, we’re proud to say welcome to our 13th and 14th stations: in Brattleboro, Vermont, station RFB and we’ll get some AM play from CKLN, Toronto, Canada. So, having patted us all on the back, let’s get down to business. I’m proud to have as our guests tonight on Cultural Baggage, two gentlemen, leaders in the effort to provide adequate medication to those in severe, intractable pain. We have with us Dr. Joel Hochman, the founder and executive director of the National Foundation for the Treatment of Pain and Dr. Stratton Hill, professor emeritus of medicine, who pioneered new pain treatment strategies at world renown M.D. Anderson hospital. Gentleman, thank you and welcome to Cultural Baggage.
Dr. Hochman: Thank you.
Dr. Hill: Thank you.
Dean: If you would, please tell me…first tell my audience a little more about yourselves and the work you do and let’s start with you first, Dr. Hill.
Dr. Hill: Well, of course I’m still seeing some patients out at M.D. Anderson, but I don’t take any new patients. I’ve been working currently with trying to change the medical practice act which comes up for sunset this year, well actually in 2005, the next legislature is going to have to deal with that, to try to clean up some of the onerous and ponderous and burdensome barriers that doctors have to face in prescribing opioids adequately for the persons in pain and we’re hopeful that this is going to bear fruit in this coming session.
Dean: Thank you, sir. And Dr. Hochman, please.
Dr. Hochman: Well, I’m, as you mentioned, the executive director of the National Foundation for the Treatment of Pain, that’s at www.paincare.org. That site gets 15,000 hits a day. We have 3,000 dues-paying members across every state in the union and 13 foreign nations. The objective of the Foundation is to guarantee to legitimate intractable pain patients that none of them will go without proper medical care, even if they have to fly to Houston to get it. I have a very busy practice, medical practice, taking care of intractable pain patients and also I’ve been very politically involved in various associations and working to try to, as Dr. Hill is trying to, to inject rationality and evidence based medicine into the arena of pain management. There are 17 million, at least, intractable pain patients in the United States. If you go to that web site you will read and see from what they have to say what the status is of pain management in the United States, and it is beyond disgraceful. It is an outrage.
Dean: Thank you, gentlemen, both. Now, we’ve come at this from different directions. I think we’ve perhaps arrived at much the same conclusion, though. That I’ve thousands of patients, maybe some of your…you know your patients along the way. People that have suffered in many ways from pain or even from just the interactions of life, leading them down a road of misery of one type or another and how this drug war steps in the way of progress in many ways, from many different directions.
Dr. Hochman: Well, the drug war has, from a physician’s point of view; the drug war has become a war on doctors who dare to competently and adequately treat pain. The data now is that probably, at the wildest estimate, there may 30 to 40 thousand doctors out of the million doctors in the United States who hold a narcotics license, there may be 30 or 40 thousand who are willing to effectively treat pain management…provide pain management. And in 2002 about 600 of them were prosecuted by the DEA which gives you a ratio of about one out every 80 practicing, full-time pain management doctors became a victim of the war on doctors and since the rate of incidence is cumulative, if you add another 600 in 2003, that’s about 1,000 to 1,200 doctors have gone through a career shattering experiences out of perhaps 40,000, so that’s one out every 40 practicing pain management doctors has gone through this. So it’s an outrageous situation and it’s no wonder that very few doctors are willing to treat patients in pain, which is particularly ironic since, as I’ve written, “Ask not for whom the bell tolls, it tolls for thee.” Whom among us gets through life their experience of intractable pain? Intractable pain is an inevitable consequence of any chronic illness and we all suffer inevitably chronic illnesses, be it arthritis or…(unint.)…or migraine or cancer. 75% of patients, terminal cancer patients, based on a survey last year, 75% of them die in inexcusable agony from inadequate treatment of their pain. It’s all because of the mythology of the addiction from opioids, that if you take opioid medication you’re inevitably going to become addicted, which is complete mythology. I’ve even had patients tell me that doctors have told them, “You can’t take these medicines because it will destroy your brain, it will destroy your liver.” When the truth of this matter is that these medicines are among the safest medicines prescribed in medicine today and in contrast…well, for example, there’s not one documented case of a patient dying from an overdose of oxycotin when they took the medicine as prescribed by their physician. In contrast, 17,000 people died from Tylenol toxicity the last year they have data. So, I mean the reality is, if you look at it rationally, Tylenol is a very dangerous drug; it’s un-regulated, over-the-counter. Opioids, which are extremely safe medications when taken as prescribed, and very effective, life-saving for an intractable pain patient, these are the focus of a campaign to absolutely discourage physicians from prescribing them. Meanwhile, illicit opium products are more available than ever. The street traffic is growing. The poppy production is growing. It’s a $500 billion international narco-conspiracy. Where’s the money going, folks? It’s certainly not going in any legitimate direction. 38% of the Gross National Product of Mexico is derived from illicit drugs. Where’s the money going? One philosopher once said, “If you really want to understand any human phenomenon, look for the money.” I’d suggest we do the same in this area of drug mythologies. Who is served by these mythologies?
Dean: Very well put, sir. Thank you. Dr Hill, you’ve been involved in this…looked at it over decades, seen some of the changes that were brought about in Texas. Tell us about that history and perhaps where we’re headed now.
Dr. Hill: Well, at first we saw problems with regulatory agencies, and we now see that these…not only do we see regulatory agencies involved, we see that the criminal justice system is getting involved. So, doctors are not only being sanctioned by their licensing boards and disciplinary boards, but they are being charged with crimes, and a lot of doctors are going to jail. We started in 1989 and Texas was the first state to pass an intractable pain treatment act which we thought was going to help the doctors, to give them some assurances that they could practice in a safe pain practice, but that really didn’t do very good…do very well. So we then had the board of medical examiners to adopt some rules that are guidelines to implement this intractable pain treatment act. But we found that the board simply ignores those rules and that we’re seeing that more and more, that the regulatory agencies are influenced by this mythology that Dr. Hochman has talked about because it’s so ingrained in our culture that I think some patients and the society in general feels like that if there’s a change we are sort of betraying our whole society. Law enforcement people have gotten into the act because they basically are dictating medical practice because they’re saying that you can only give so much medication. They are saying that physicians should have known that this person was an abuser of drugs, should have known that they may be involved in some criminal activities. They accuse physicians of conspiracy and distributing these medications. So, what I think is happening is not a overt conspiracy, it’s a silent, unspoken conspiracy among health care providers, doctors and so forth, to give sub-optimum treatment to patients so they do not raise a red flag to cause any notice to their practice by the licensing boards and certainly the law enforcement agencies. So, it’s really changed from strictly a regulatory thing to regulatory and law enforcement. So, one could conclude that the war is getting more severe.
Dean: In some ways, you’re right. I think that’s so true. I want to talk about last month’s issue…this month’s issue of Reason magazine. There was a story in there, a “Dr. Feelscared” (http://www.reason.com/0408/fe.ms.dr.shtml), which talks about many of these same problems, same situations y’all had brought forward and Steve, let’s go ahead and take that one minute break, and we’ll be right back.
(Audio Track) Musical interlude - MPP plug - “Name That Drug!”
Dean: Ok, did anybody name that drug? That was a repeat. You should have gotten it. Many of these clinics that the DEA sees too many drugs being prescribed by the clinic, calls it a conspiracy and arrests everybody including the receptionist. There’s some terrible stories in that regard. Y’all want to talk about that?
Dr. Hochman: Well, last year, no, year before last there were, according to DEA statistics, there were 88 instances in which physicians were arrested in their offices, often at gunpoint, often by SWAT teams. And there were instances in which the staff were placed on the floor with guns to their head. Typically what happens is they’re charged with kingpin drug conspiracy laws so all their assets are confiscated. They can’t afford to retain counsel to defend themselves. They’re coerced, therefore, into accepting plea bargains, accepting guilt on poor legal advice. It basically ends up that their entire career is destroyed. It’s over for them, professionally. That was 88 times last year and the excuse always is, “Look, the streets are awash with these drugs.” “There’s a crisis in Kentucky with Oxycotin and it’s the doctor’s fault. They’re just nothing but dealers in white coats and, of course, the whole thing is based on no logic, no rationality and no facts. It’s all hysteria. It’s all propaganda. And it’s all mythology. My concern is that, my goodness, what is happening to our society? Where’s the value of intelligence, of intellectual decision making, of rational and critical thinking? It’s all in a… tossed in a hand-basket while sound bytes and tabloid mentality prevails. In fact I think it’s basically the issue in the upcoming election. Does it make a difference… do you have to wear a turban to be a Taliban – to be an extreme radical thinking person – that you have a set of beliefs and anyone who disagrees with you is some kind of a communist or a subversive or a criminal or should be destroyed? I mean, we have that kind of thinking in every quarter now. It’s not just something we have to fight in Afghanistan. I think it’s a world wide issue.
Dr. Hill: Well, the bottom line in all of this is that the people that suffer the most, I mean doctors… it’s terrible what they do, but – I mean what they have to go through – but – what they do to doctors – but the patient, in the long-run, is the one that suffers here. Because when the y make these raids and some of them are very dramatic, as Joel has said. One time, I think it was in Indiana, they landed in a Helicopter on a busy city street, stopped all the traffic, went inside in all this gear, arrested the doctor, and about a year later, the newspaper reported something that said, “With no more fanfare than a stamp in an office,” they dropped all the charges against that doctor. What did they do? They confiscated all the doctor’s records, so when they do that, the doctor then tries to place these patients with other doctors. It’s very difficult, almost impossible to get another doctor to take a patient like this. But then the first thing that a physician wants to see, when the take a patient like that from another physician, is say, “Let me see what’s going on in the past.” “How can I give…
Dr. Hochman: “I have to review the medical records.”
Dr. Hill: give this patient the right treatment.
Dr. Hochman: Right.
Dr. Hill: You know, I don’t repeat, I don’t have to do all this stuff…” There’s no records. And so a doctor is doubly reluctant to take a patient under those circumstances. So these raids that they do are just very destructive for patients and I think, basically, the reason why it’s prevalent with physicians, it sure is easier to go after physicians than it is the Medline cartel. (laughter) The cartel shoots back.
Dean: That’s right.
Dr. Hill: Doctors don’t.
Dr. Hochman: And they have money for lawyers. (laughter)
Dean: I wanted to make a point in support of what Dr. Hochman has said, and I think it was last week, perhaps the week before, the HHS, the health and Human Services, put out a memorandum to their staff that they were no longer to attend World Health Organization meetings without approval of someone at the, you know, the top of the command chain. It just seems that we’re shrinking science. We are going back to a bit of a medieval way of…
Dr. Hochman: Stem cell, so, I mean there it is, right there.
Dean: Yes, sir.
Dr. Hill: Well, I think actually, we did better in medieval times. (laughter) Let me tell you.
Dean: The leeches actually worked in some cases, yes.
Dr. Hochman: Let me give you a single example of how this works. Richard Weiner was the founder of the American Academy of Pain Management (http://www.aapainmanage.org). About 3 or 4 years ago, Richard developed pancreatic cancer, which is one of the most painful conditions known to medicine. Dr. Weiner could not find anyone in the entire city in which he lived willing to write opioid prescriptions for him in his agony, in his terminal agony. The president of the American Academy of Pain Management at that time, Dr. Barry Cole, had to fly from Hawaii to California to write prescriptions for his colleague, Dr. Weiner, and that man was the founder of the American Academy of Pain Management. So, if someone of that stature can’t get his pain recognized as legitimate and get a physician courageous enough to prescribe for him, what chance does the ordinary person in agony have of getting legitimate care.
Dr. Hill: Oh, Joel, you must have a hundred letters and a hundred e-mails on your website with that story over and over again.
Dr. Hochman: Over and over and over again and patients going, legitimate patients, patients with (uint.), bleeding out of the rectum, going to, if the can find a physician to write the order, the prescription, going to a pharmacy and being literally, physically thrown out of the pharmacy by some brobdingnagian pharmacist accusing them of being a drug seeker and a seeker and “get out of their pharmacy” and “don’t you ever come back here again” in front of a crowd of others. It’s just outrageous.
Dr. Hill: Well, I had a doctor in California who asked me to help her, which I was unable to do because they finally took her license away from her, but they came into her office and made her give a urine sample right there on the spot and her – she didn’t have to give the urine specimen in front the patients that were in the waiting room. They took her in there and said, “You’re going to give us a urine specimen” right then and, you know, she – they accused her of being, of using these drugs.
Dr. Hochman: Well, the whole notion of probable cause, of due process, it’s all thrown out the window and the excuse being the eminent danger to the public of drug addiction.
Dr. Hill: Well, you see, I think that if…
Dr. Hochman: If pain patients don’t get addicted…
Dr. Hill: But in the law, in Texas, it says that if a physician should have known – now if they apply – I mean, that this person was going to abuse some drugs or something like that. Well, that takes a pretty good clairvoyant physician to know that. So, if you apply that to Ken Lay, he should have known about what happened in Enron. He’s a dead duck.
Dr. Hochman: And the President should have known that the intelligence about weapons of mass destruction was unreliable. I mean, it’s the same notion and the gun shop owner should have known that the gun he sold seven years ago was going to get in the hands of somebody who’s a criminal. It’s just – the whole situation is just irrational, insane, hysterical. And as I’ve said a thousand times now, look folks out there, there are no drug problems. I’ve been saying this for 30 years now. There are only human problems and one of those problems is some humans try to medicate their problems with drugs. Treat the people, not the drugs. The supply-side approach is bankrupt.
Dr. Hill: Yeah they – aberrant behavior is not, does not reside in the drug.
Dr. Hochman: Right.
Dean: Right. It’s in the lifestyle that grows up around the prohibition those drugs that many of these problems begin to occur.
Dr. Hochman: Well, if we just simply apply intelligence and rationality to any problem, that’s the first step toward solution and the data has been in for two decades now. You want to treat an abuse problem or an addiction problem? You provide treatment not incarceration. Nobody ever got well in jail.
Dr. Hill: You’re talking about these cases, here. Joel and I are involved in a case of Dr. Bill Horowitz in Washington. He has been harassed by the authorities and this time it’s a criminal case. He has been…
Dr. Hochman: Life sentence.
Dr. Hill: He will never get out of prison and he’s treated patients that can’t get treated anywhere else. He’s had patients – because I’ve examined his records – come to him from Washington, from Winter Park, Florida.
Dr. Hill: He’s had them from Greeley, Colorado because they can’t get treated. And one of the patients from Winter Park, Florida drove non-stop because she had a antique shop and couldn’t afford to have somebody watch it more than a day or two. She would drive non-stop from Winter Park to Washington D.C so she could see him because the authorities required that she come every so often and she had eight of the hundred microgram per hour patches of Fetinel and was able to drive up there and back on numerous occasions. So there’s something different about people who have pain.
Dean: And to have that much commitment to it, and etcetera shows irrelevance.
Dr. Hill: They’re trying to put him in jail.
Dean: We got about two minutes left and I wanted to address this one thought within this “Dr. Feelscared” from Reason magazine. There was talk of some of these clinicians having been thrown to the floor, shackled and so forth and lose basically all hope. Being forced to either testify against their fellow clinicians or go to prison. That they actually hung themselves or committed suicide in other ways.
Dr. Hochman: Dr. Benjamin Moore.
Dr. Hill: Yeah.
Dean: Yes, sir. What an outrage that is.
Dr. Hochman: Well, another physician in Louisville, Kentucky, about a month ago, did the same thing. He committed suicide – and his lawyers said, “I thought we had this case almost where they were going to dismiss it.” But he was so fed up; it took so long that, and then the feds were coming in and he had to face up to criminal charges so he just killed himself.
Dean: Well, gentlemen, I want to give you about 20 seconds each to just talk to my audience. You want to give them a website or whatever? Dr. Hill, you first. I mean, Dr. Hochman first.
Dr. Hochman: Well, again www.paincare.org and we have a million dues paying members. We will do something in the Congress, I promise you. And, you know, join with us. Every additional membership gives us more power.
Dr. Hill: Well, the only thing I can say – I don’t have a website – but what we’re trying to do is to work within the system to change it right now so that doctors will feel more secure in dealing with what they have to do right this minute.
Dean: Well, Dr. Stratton Hill, Dr. Joel Hochman, gentlemen, I thank you so much for joining us tonight on Cultural Baggage a couple of program notes: next week the network will receive a half-hour show on the Drug Czar himself, his visit to Houston. I want to thank Philip Guffy for doing our transcriptions. We’re going to be doing that on regular basis. I urge you all to make use of these programs and this one tonight included. Make quotes available. Send them in letters to your editor and use them and, you know – the main thing, my friends, is we, working together, can make a difference. This drug war is a hopeless fraud. No one from the other side dares to come on the battlefield. The Drug Czar even runs from me. And, so therefore, I ask you to just do something. Write that letter, call you Congressman. But remember, because of drug prohibition, you don’t know what’s in that bag. I urge you to please, be careful.
(Audio Track) ending.