WHY DR. HURWITZ?

I spoke with Dr. William Hurwitz today. He called me on my cell
phone. He is now out of jail after two weeks and is under "house arrest".

The National Foundation for the Treatment of Pain has already taken a
position on Dr. Hurwitz. The appropriate Executive Director's message on
the Foundation's web site (www.paincare.org) contains those opinions. It
is sufficient to say, by way of review, that Dr. Hurwitz is a board
certified physician and an attorney. He is highly respected by his
patients, his colleagues who know him, and by his friends and family. To
accuse him of being a king-pin drug dealer, conspiring to distribute
narcotics, is an historical obscenity. In my personal view, his case will
become the "Dreyfuss Affair" for this century.

In the next two weeks I will publish the files of those patients of his
whom I have attended since he closed his practice. I believe that these
records will speak for themselves. All are unarguably legitimate
intractable pain patients. All have succeeded in recovering their lives
through the use of opioid medications. With a few highly aberrant
exceptions, all are, by all information and appearances, decent, deserving
human beings. I have no reason to suspect them of diverting or abusing
their medications. They are stable on their treatment regimen. They have
achieved a pain level of from 3 to 5. This permits them to be reasonably
functional. They have not suffered any adverse effects or complications
from their treatment. They have consistently maintained their weekly
record of treatment. They are in compliance with their treatment
agreement. Their dose and schedule of medications is stable and effective.
I will also compare their current regimen with that of Dr.Hurwitz, when the
cases are posted (with the patient's permission.)

Why then, is Dr. Hurwitz being prosecuted?

1. To begin, we should consider the fact that John Ashcroft, Attorney
General under Mr. Bush1s Administration, has stated publicly that he
considers doctors who prescribe medications that are diverted and abused as
no better than the Taliban, and that he intends to use every device against
them that is used against the Taliban. In this statement he reveals the
fanaticism that is the engine of the Bush Administration.

I will not belabor the subject at this time. It is sufficient to say that I
can find no distinction between religious fanaticism of any type. It
matters not whether a fanatic wears a turban and never shaves, or wears
$2000 suits and rides around in limousines. If people harbor extreme
religious beliefs, seek to impose those beliefs on all others regardless of
the human and social costs, and are willing to employ any means to do so,
they are all, equally, fanatics.

2. It is my conclusion that Dr. Hurwitz is being prosecuted because he has
offended fanatics within the current administration. These are people who
fanatically believe that any person who uses opioids consistently is an
addict, and that any doctor who prescribes for them is a "dealer in a white
coat".

This belief is bizarre and indefensible. When any fanatic holding such a
position is subjected to pain, they will immediately surrender their
misguided belief and beg for help. Except for masochists, whose
psychoneurology is wired up so that pain is experienced as pleasure, no
human being can tolerate relentless and uncontained pain. Relatedly, any
physician who has ever advised a patient to "learn to live with their pain"
is instantly revealed as a fool and a charlatan.

3. I have further concluded that the prosecution of Dr. Hurwitz is not
necessarily related to any belief that a conviction will occur. The
prosecution, itself, is sufficient. It has already caused him enormous
hurt and damage. He has been forced to close his practice of medicine. He
has suffered the humiliation of being arrested in front of his two young
daughters. They will never forget this horrendous experience and he will
never be able to relieve them of it.

He took it upon himself to become a pioneer in the treatment of intractable
pain. He further dared to succeed in defending this treatment before the
Virginia Board of Medicine, and to secure favorable publicity and national
support for pain treatment, when opiophobia still prevailed
widely. Lastly, he pursued aggressive treatment of pain with short-acting
pain medicines. To succeed in controlling his patients' pain he frequently
had to employ substantial doses of morphine, oxycodone and hydromorphone.
Because these drugs, all placed in Schedule II of the Controlled Substances
Act, are available only in small doses, he frequently had to order them in
large numbers. To order 2000 Percocet per month for a patient, in a
climate of opiophobia and clinical ignorance, was audacious and challenging
to law enforcement. To do this for 100 patients was intolerable to the
fanatical. It did not matter to either that short-acting opioids cost
pennies per pill, while long-acting medications, such as OxyContin, Kadian,
Avinza, Duragesic and Actiq, cost many dollars for each dose. The sheer
number of pills prescribed by Dr. Hurwitz was sufficient evidence to
convict him in the minds of drug enforcement agents who had no medical
knowledge whatever.= Lastly, there was also the problem of diversion.

4. It is part of human nature to sometimes surrender to obsession and
extremes in behavior. The Childrens' Crusades during the Middle Ages; the
Nazi Holocaust; genocides in Africa; and hundreds of other examples,
clearly expose this horrific quirk in human nature. The current 3War on
Drugs2 is simply another example of fanatical extremism. A "drug-free"
society is as plausible and likely as a sex-free society. The historical
landscape of sexually cloistered communities is cluttered with episodes of
orgy and excess. But even in this 21st century the fanatical goal of a
drug-free society persists.

Added to this quirk in human nature is the quirk of selfish interest. It
is very difficult for most individuals to admit that they are motivated
entirely out of selfishness. It is far easier for them to rationalize that
what they are doing is out of a desire for the Public Good; this is
precisely so for anti-drug "warriors". They are promised a lifetime job,
annual cost-of-living raises, vacations, continuing education, health
insurance and the privileges of being "on the right side of the law". All
they need to do to secure these advantages is to pursue the 3evil2 of
drugs. It should not surprise anyone that a half-million people have
enlisted to seek the "drug-free society", either knowing full well that
this is an absurd quest, or indulging in complete self-delusion. The
rewards are simply too great. The current banner under which these legions
march is the "evil" of drug diversion.

Here again, vagueness serves a valuable purpose - the wider the definition,
the greater the "evil". Virtually every household in the nation has seen a
spouse, relative or friend "divert" a prescription medication to someone in
acute need. However, the term is also used to include the diversion of
legitimate medication to the black market for sale at great profit. The DEA
now frequently cites that "15% of all prescriptions are diverted". This is
the raison d'etre for the latest focus of the "Drug War". Interdiction of
massive amounts of illicit drugs smuggled by international
narcotrafficantes is dangerous and fruitless, and serves only to get agents
tortured and killed (and to maintain the prices.) Pursuing diversion is a
comparatively safe and cozy activity. Few doctors carry weapons and torture
and murder agents. Few neighborhood pill sellers are murderously "bad"
people. Merely the threat of imprisonment is sufficient for them to "roll
over" on any doctor they have ever seen, and to perjure themselves in any
way the DEA asks. Most of them conveniently adopt the propaganda that the
doctor was "really just a pusher" it immediately neutralizes their
immorality and betrayal of trust.

Using the putative frequency of "diversion" as its justification, the DEA
now is spending millions of dollars attempting to "root out the bad
apples"= in medicine. They would have us uncritically accept their claim
that 1 out of every 1500 doctors in 2002, 1 out of every 750 in 2003, and 1
out of every 375 in 2004, is a bad apple. Not only is this a ridiculous and
unsupportable claim, but it flies in the face of the truth. Doctors who are
willing to throw their career out the window for a few thousand dollars are
so rare as to be statistically insignificant. I have personally reviewed
the medical charts maintained by doctors who have been the object of such
accusations. Not only was their treatment medically necessary and within
the scope of legitimate medical practice, it was also effective in
permitting the patients to maintain a reasonable quality of life. Further,
their compensation for this pain management was typically minimal, as most
pain patients are permanently disabled, poor and/or on Medicaid. So, for
$65 per patient, per month, the DEA would have the American public believe
that hundreds of doctors, who have spent half their lives preparing for the
practice of medicine, are really criminals conspiring to get illegal drugs
out to an innocent and unsuspecting public.

In the final analysis Dr. Hurwitz is being prosecuted to prove this theory
and to therefore justify the current chapter in the "War on Drugs". In
inciting and allowing this despicable campaign the current Bush
Administration is eating its own children. It is recklessly and
shamelessly pursuing its fanatical vision of a drug-free society with
contempt and indifference for millions of innocent pain patients and
thousands of brave, dedicated and principled physicians. And it is doing
this by a traitorous betrayal of their oaths of office, through the
ruthless employment of lies and fascist fanaticism, and through the use of
cynical manipulation of terrified addicts and low level drug dealers.

Dr. Hurwitz, his patients, all pain patients, all physicians, and the
American People, deserve far better than this. In the coming elections the
political position of every candidate can be fundamentally evaluated by
their stand on these essential issues. If they are not honest, brave and
patriotic enough to stand up for what is right and to cease this outrage,
then they are not qualified to serve in public office at all.