Pubdate: Fri, 02 Jun 2006
Source: Reason Online (US Web)
Copyright: 2006 The Reason Foundation
Contact:  http://www.reason.com/
Details: http://www.mapinc.org/media/2688
Author: Maia Szalavitz
Note: Maia Szalavitz is a senior fellow at stats.org, a media 
watchdog group, and author of Help At Any Cost: How the Troubled-Teen 
Industry Cons Parents and Hurts Kids.
Bookmark: http://www.mapinc.org/find?232 (Chronic Pain)

"THE DOCTOR WASN'T CRUEL ENOUGH"

How one physician escaped the panic over prescription drugs

When Dr. Paul Heberle was arrested last April, dozens of chronic pain 
patients were left in agony. One of Heberle's patients called no 
fewer than 37 doctors seeking care--all of whom refused to see him 
once he revealed the name of his prior provider. Finally, Robert 
Holmes, a 40-year-old man who suffers from a lung injury and requires 
supplemental oxygen to breathe, resorted to visiting a methadone 
clinic for drug addicts. He was turned away there, too. More than 
twenty others reported similar experiences at a meeting of patients 
affected by the arrest. Six would later attempt suicide.

For many patients, the situation was devastatingly familiar. Heberle 
had agreed to care for many of them after their previous physician 
was arrested and then convicted on some of the same charges that 
Heberle now faced: illegal prescribing of narcotics. That doctor, 
David Klees, got 12 to 24 years in prison. This time, however, the 
government would find it wasn't so easy to railroad a pain doctor.

In the last five years--since a media panic over prescription drug 
abuse began with law-enforcement-driven reports of an "Oxycontin 
epidemic"--dozens of doctors have been prosecuted for 
"overprescribing" painkillers. The Justice Department and the DEA 
have pushed this aggressive new campaign in the war on drugs.

Overwhelmingly, these cases have resulted in convictions with heavy 
prison terms--or plea bargains with shorter sentences that 
nonetheless drove the doctors out of medicine. Advocates for pain 
patients report that, as a result, relief has been increasingly hard to find.

Fortunately, Heberle had an ally that Klees didn't: Siobhan Reynolds 
and her Pain Relief Network. As the DEA and local prosecutors went as 
far as creating a poster with Dr. Heberle's picture and the words 
"overprescribing controlled substances" and "Medicaid fraud" on it, 
Reynolds visited Erie, PA, to organize Heberle's patients and, for 
once, get their side of the story into the media.

Nearly all of the prior cases have followed a similar pattern. First, 
prosecutors blitz local media with reports of out-of-control 
prescription drug abuse problems and discuss the problem of "pill 
mills." Then, they swoop in with a SWAT team and arrest any doctor 
brave enough to actually treat chronic pain with doses of opioid 
medication large enough to work. They call him a "drug dealer" and 
"pusher with a pen."

Next, the prosecution brings out addicts for the cameras, who claim 
the doctor treated them without examining them and "caused" them to 
develop drug problems--but they don't mention the addicts' motivation 
for cooperating. In virtually all of these cases, addicts are 
motivated by reduced or dropped sentences charges from prosecutors, 
or by the hope of suing the doctors who got them "hooked." 
Prosecutors also usually fail to note that for most of these addicts, 
this is far from their first run-in with drug problems or the law.

At some point, however, the government team brings out its most 
devastating weapon: weeping relatives of patients who have died while 
under the doctor's care. Reporters are rarely keen to grill the 
grieving, so their stories tend to stress the prosecution's talking 
points rather than the fact that these deaths are virtually always 
either deliberate suicides or overdoses resulting from deliberate 
misuse of prescription medication. In the Heberle case, the death 
that started the investigation involved someone who had eaten a patch 
meant to be worn on the skin--thus immediately ingesting three 
days-worth of drugs.

Usually, the media buy the tale of evil substances and vile 
physician-pushers. But Reynolds offered a more compelling alternative 
narrative. She brought the suffering patients into the media eye. 
Rather than telling the tale of an evil drug-dealing doctor who 
brings down the poor addict, she and the patients provided another 
version of the story, in which the wonderful healer allows his 
grateful patients to function--until the cops drag him away.

And in fact, Reynolds' account is more accurate. Some 90 percent of 
people who abuse Oxycontin also have histories of using cocaine and 
psychedelic drugs. Were most of these people innocent "victims" of 
evil doctors? Isn't it more likely that they were prior heavy drug 
users who sought additional drugs and, because there's no objective 
way of measuring pain, were able to get them from compassionate 
doctors? Aren't doctors who do believe people's accounts of pain 
exactly the ones we want in practice?

In the Heberle case, one prosecution expert told the Erie Times-News 
that the doctor was:

"prescribing painkillers to patients with documented prior 
substance-abuse problems and/or mental impairment."

The paper didn't note that there is nothing illegal about this. Nor 
did the reporter seem to realize that there's something profoundly 
sick about assuming that people who are mentally impaired or have a 
history of drug problems never need strong pain medication.

Fortunately, in the Heberle case, the jury didn't buy the lies. 
Heberle made no profit from the prescriptions he wrote; he was a 
former addict himself who was monitored for abstinence. What possible 
reason could such a person have for deliberately supplying addicts? 
The only sensible way to see him was as a caring physician, who, like 
anyone else, does not have a "pain-o-meter" or fool-proof lie 
detection device in his head or office.

The defense presented expert testimony that laid out the complexities 
of pain treatment. Although the prosecution essentially put on a 
malpractice case--representing violations of the standard of care as 
criminal when they actually are civil violations--the defense beat 
them back. Their cross examination of a prosecution witness who 
claimed that certain opioids should only be used for cancer pain was 
especially effective. The defense simply exhibited a small practice 
guide which shows that the medications are recommended for other pain as well.

Also effective was the defense expert, Frank Fisher, MD, one of the 
few physicians to be exonerated after being prosecuted for 
over-prescribing. He called the prosecution "a crime against 
humanity," and in conjunction with the defense team, debunked the 
idea that cutting off pain medication to people with past or even 
present addictions does anything to help them.

"They showed addictionology for the sham science that it is," says 
Reynolds, explaining that in previous cases, the defense often had a 
hard time getting the jury to see that medications can't "make" 
people into addicts and that no one, addicted or otherwise, benefits 
from a system where doctors presume all pain is faked.

"The government position is that the doctor wasn't cruel enough," she 
adds, describing how hard it was for previous defense teams to debunk 
the notion that addiction can be prevented or treated by stopping or 
failing to prescribe pain medication.

"By making the pain patients real, we made the good guys and the bad 
guys change places--and that's hard to do," she says.

Last week, Heberle was found not guilty on all charges. 
Unfortunately, at least one patient did not live to see the verdict-- 
she had committed suicide, unable to find another doctor to prescribe 
the medications she needed. And Heberle, like Fisher, will no longer 
practice medicine, leaving many patients still without help.

As Reynolds asks, "How can they call this protecting the public 
health?" We hope the Heberle case is the beginning of the end of 
these senseless prosecutions.
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MAP posted-by: Richard Lake