HOW GOOD IS E.R.'s Rx?

The Season Finale Highlights A Speedy New Way To Detoxify Addicts But
Broadcasts The Wrong Message

Most TV viewers tune in to medical dramas like E.R. and Chicago Hope for
the drama, not the medicine. But it's hard not to pick up a little medical
lore along the way. Take the final episode of E.R., for example, in which
George Clooney, in his role as Dr. Doug Ross, faced censure for his
unauthorized use of a procedure called ultrarapid opiate detoxification on
a tiny patient--an infant born to a heroin-addicted mother. After a
harrowing all-night vigil, during which the infant hovered near death, the
detoxification was a success and the baby drug-free. Grateful and
overjoyed, the mother pleaded with Doug, "Can you do it to me?"

The message taken home by millions of E.R. viewers is that ultra-rapid
detox is a shortcut to drug withdrawal. And that's a problem, say many
doctors. They fear it will result in a stampede of new patients to the
controversial and still experimental procedure. Ultrarapid detox, they
charge, has not been adequately studied and is often promoted by medical
entrepreneurs who make exaggerated claims and operate out of hotel rooms
and storefronts.

Of greater concern, a report released two years ago by the National
Institute on Drug Abuse warned that the technique involves an
"unacceptable" risk of death, and a review article in the Journal of the
American Medical Association last January concluded that existing data do
not support the safety of the process and that more study is needed to
determine its efficacy. Says Dr. Thomas Kosten, of Yale University School
of Medicine, who co-authored the journal review: "It's like using a cruise
missile when all you need is a hatchet. It's overkill. Opiate detox is not
that hard to accomplish." In May 1997 the British Medical Journal reported
that a patient had died while undergoing the procedure.

Addicts who can afford ultrarapid detox--the procedure costs as much as
$10,000--are attracted to it because they can escape days and even weeks of
agonizing withdrawal symptoms. They are given an antagonist, usually
naltrexone or naloxone, that quickly displaces opiates and attaches itself
to the same brain receptors that opiates seek out. During the several hours
of detoxification, patients are under general anesthesia and unaware of the
severe "shake and bake" symptoms they are enduring. Still, they are often
dizzy, exhausted and barely able to walk after awakening. And they need the
same follow-up counseling and treatment as conventionally detoxed addicts
to keep them from slipping back into their old habits.

The largest purveyor of rapid detox is the Center for the Investigation and
Treatment of Addiction, which pioneered the technique and opened its first
clinic in Israel in 1993. It has since expanded and changed hands several
times, franchising clinics in several countries and treating thousands of
addicts--to a drumbeat of criticism. The British medical journal Lancet,
for one, has blasted CITA for exploiting "the hopes and fears of opioid
addicts and their families [and] for making exaggerated claims."

CITA currently has four clinics in the U.S., all of which are affiliated
with major hospitals, and charges $6,800 per treatment. But it is not the
only game in town. Storefront clinics, using variations of CITA's patented
procedure, have sprung up across the nation, and a California entrepreneur
is selling franchises for at-home detox centers for $1,000 apiece.

It is these treatment boutiques and the businessmen who are promoting them
that have given rapid detox a bad name, says Dr. Ron Wender, head of
anesthesiology at Cedars-Sinai Medical Center in Los Angeles. Wender's
experience at the CITA center at Cedars-Sinai has convinced him that
ultrarapid detox, properly performed and with appropriate follow-up,
"should be welcomed with open arms."

What prompted E.R.'s producers to air the ultrarapid detox drama? Critics
point to an April article in the Wall Street Journal that detailed
instances of TV shows being successfully lobbied by medical foundations and
others to include dramatizations of specific diseases. In one example the
Journal described how the Henry J. Kaiser Family Foundation wooed Dr. Neal
Baer, an E.R. writer and producer, besieging him with studies on the
increased risk of contracting AIDS for those with chlamydia, a sexually
transmitted disease--a risk that was then mentioned on E.R.

Baer denies that he was lobbied to put either chlamydia or rapid-detox on
E.R. Chlamydia is a common problem and so, in Hollywood, is heroin
addiction; one marquee actor is reported to have gone through ultrarapid
detox just in time for this year's Academy Awards. In fact, says Baer, the
idea for the detox episode came from a pediatric anesthesiologist invited
by E.R. to help generate story lines.

That still leaves other questions on the minds of E.R. fans. Has Doug's
impulsive act jeopardized his career? Is he still on staff? Is he still the
sexiest man alive? Tune in next September.

Checked-by: Richard Lake