Opiophobia - Racism in Boards of Medicine

I posted this today as my contribution to the on-going dialogue about the persecution of pain management doctors, on the LIST serve "The Project on Pain and Chemical Dependency" (TPPCD)

I'm afraid that what we are dealing with is a form of sick human behavior. There can be no doubt that there is murderous potential in every human being. The BTK murderer is a dramatic example of this. Scout leader; church-goer; a person everyone liked; a long-term employee of an alarm company; married 30 years; father to a charming, healthy daughter; absolutely likable by all who knew him. Yet he secretly harbored a total monster deep inside. When we look around, we see that the history of humans is really a nightmare of horrors. Genocides everywhere we look. 300 million slaughtered in the last 2000 years (if not more). A madman murdering 10 innocent women in a work-out facility - just today. Religious zealots bombing hundreds of innocent people throughout the Middle East. Apparently normal American kids engaging in sexual sadism in Abu Graib. Blue collar folks turning into heartless assassins when they go to work for Blackwater (or the CIA, or state prisons, etc., etc.)

As one of my Psychiatry Professors at UCLA taught us 40+ years ago - "there should never be any doubt about what is inside human beings. The only question is how well they are handling it". (He also used to say that the only crime in psychiatry was being surprised.)

So, the point I want to make is that most people handle their internal monsters by projection. They defend themselves from the emotional trauma of facing their internal monsters by unconsciously projecting the monsters onto others. Take the example of the corrupt prosecutor - who justifies suborning perjury, sequestering exculpatory evidence, fabricating evidence, routinely perjuring ("testilying" the police officers call it) - in order to win a conviction. He (or she) rationalizes this monstrous behavior by perceiving the victim of their behavior as the monster. ("It doesn't matter what it takes me to do to convict this horrible criminal".) This dynamic plays itself out daily in every form of investigation, prosecution and judgment. This Executive Director of the California State Medical Board clearly sees pain management as a meretricious form of behavior hiding behind a white coat. So it is his "duty" to punish it. He (or she) is clueless that what they are doing is denying the most fundamental achievement of physicians since the dawn of the profession - relieving suffering. Their conviction is so intransigent that they don't WANT to interview the patients whose lives have been spared by effective pain treatment (it only gets in the way of their own disturbed emotional needs.) They simply harbor behaviors and attitudes that underlie every mindless prejudice, most notably "racism".

I am convinced that opiophobia is at the deepest level best understood as "pharmacological racism". Just as with any racist belief, it is irrational, springs from vicious and un-understood prejudice, and serves a deep inner illness in the perpetrator. Arthur is a remarkable exception, in his fair-minded rationality. I would hope that there are many like him in his profession. But I have to say that of all the Board (and other) prosecutors I have met, he appears to be a rare exception.

Historically, it took us over 200 years to shake ourselves loose enough from our melanophobia (fear of people with colored skin) and prejudice, to elect an African American to the presidency of the United States. In fact I think it may be a signal of a tidal change in the world. But I hope that it doesn't take that long to change the opiophobia that condemns millions of innocently suffering people, and thousands of compassionate doctors, to a needless hell.

For myself, I have now spent over $40,000 in legal fees dealing with 45 investigations by the Texas Medical Board, over the last two years. All but 14 have been dismissed. The remaining 14, initiated after the first 31, are excellent examples of successful pain treatment (as every patient attests in writing.) But the now Executive Director of the now regressive Texas Medical Board continues to mindlessly and shamelessly seek my destruction (Until eight years ago Texas was a leader in progressive pain managemnt policy. Mr. Bush and his doppelganger, Mr. Perry, changed all that with their appointments to the Texas Board. As Stratton Hill observes, "the opiophobes are winning.").

The pursuit and prosecution of pain management as "injudicious prescription" is simply a smokescreen for the opiophobia that motivates it. And this pursuit is one of the most common activities of State Medical Boards throughout the nation. In many states one simply cannot now find a doctor willing to treat intractable pain. Dr. Robert Kales, a consummate gentleman, an excellent physician, a wise and educated man, has now been persecuted out of Arkansas and now Oklahoma. In New Mexico, where I practiced for 25 years and served two years as the Clinical Director of all the in-patient and community based health programs in the state, a religious cult nut case spent eight years hounding me out of my home and practice, even though I referred the last 142 cases I accepted, to the Pain Clinic at the University of New Mexico School of Medicine for a second opinion and got 100% concurrence and support for my care. Joan Lewis MD, has suffered a similar fate. She now must practice cosmetic medicine because the Board of Medicine stripped her right to prescribe pain medication! How many other cases can we name? Just thinking about it makes me nauseous and disgusted. The State Boards of Medicine give lip service to their Model for the Treatment of Intractable Pain when they are in Washington, at the Federation of State Medical Boards meetings. But when they get back home it's business as usual - lynching pain management doctors. ("Some of my best friends are pain management doctors" I am sure they would say.)

I know that President Obama is aware of this calamity (one of my patients, a victim of intractable pain, the son of a prominent newsman, spent half an hour with him during the campaign, smoking cigarettes, and told him his whole story - for which the then Mr. Obama thanked him - "I had no idea that this was happening, Mr. Obama told him. "But I know about it now".). It is on his list of priorities for change in America. But, unfortunately, it is a ways down the list, under the economy, Iran's nuclear development, reform of Health Care, reforming Drug Policy, congressional corruption by lobbying and special interests, etc., etc.

So, I don't know what more we can do except what we have been doing. Talk about it, write about it. Give interviews, write articles, do research (Craig - where is that damned, history-changing manuscript?), share our knowledge and experience at every opportunity, defend the truth, uphold reality and factuality, defend rationality and science to the death. For myself, if the epithet on my tombstone reads, "they may have destroyed his career, but they didn't touch his convictions, his integrity, or the scientific truth" I will smile proudly for eternity.

JSH