Bombing the Arkansas Medical Board

Bombing the Arkansas Medical Board

Arkansas: Doctor Found Guilty in Bomb Attack
By ROBBIE BROWN
Published: August 9, 2010
NY Times

A federal jury on Monday convicted a physician of conspiring to detonate a car bomb that badly injured the state medical board chairman. Dr. Randeep Mann faces the possibility of life in prison in the February 2009 bombing in West Memphis, Ark., which left the board chairman, Dr. Trent P. Pierce, badly scarred and partly blind. Prosecutors said the bombing was in retaliation after the board twice sanctioned Dr. Mann for overprescribing pain medication. Dr. Mann’s wife, Sangeeta, was convicted of conspiring to conceal evidence. Prosecutors say that they do not believe the Manns planted the bomb, but that Dr. Mann ordered an unknown person to do so.
---------------------------------------
I cannot condone bombing anyone or anything, but I can certainly understand the depth of anger and frustration Dr. Mann must have experienced.

The Arkansas Medical Board is a leading terrorist organization, in my opinion, in the opiophobic campaign against opioid prescribing doctors. This same Board, under the generation-long reign of a Dr.Juette, persecuted Dr.Robert Kales (a fine physician)right out of the state, and personally tyrannized the state's medical community. Perhaps it was no coincidence that Juette was also the medical director for Walmart, which certainly didn't want to pay for pain medications for injured employees. Juette made sure they didn't. Apparently his successor shares the same mission. Now he has to pursue it from a wheelchair, with one eye.

When the People wake up to the venality, cruelty, selfish self-interest, opiophobic "racism" and plain stupidity that supports this denial of legitimate pain care, they will rise in revolt. It can't come a day too soon for me. We don't need to use actual bombs. We just need to set a political bomb under our chicken-hearted and/or misguided lawmakers. They either need to do the job right, and intelligently, or they need to find another job.
Dr. Hochman

Prescriptive Drug "Abuse"- the REAL facts

Emergency Department Visits Involving Non-medical Use of Selected Prescriptions - Unites States 2004-2008 MMWR 2010;59:705-509
JAMA, August4, 2010 -Vol.304, No.5, p 515

"In contrast to the results of this study, NSDUH (National Survey of Drug Use and Health) results have shown no increase in self-reported rates of non-medical use of selected pharmaceuticals since 2004. Increasing ED visit rates in the context of stable self-reported nonmedical use rates might indicate that persons seen in EDs are different from typical respondents to NSDUH; a shift towards riskier types of pain relievers and benzodiazepines, riskier modes of use, more frequent or heavier use; and/or an increased tendency to seek emergency care because of greater awareness of the serious consequences of nonmedical use of such drugs."

I have repeatedly pointed out in responses to the FDA's proposed REMs on opioids, on the web site of the National Foundation for the treatment of Pain, on the blog: jfshmd.blogspot.com, and in e-mail to journalists, attorneys, federal and state representatives, precisely what is reported above - that government sponsored research has shown no increase in self-reported rates of non-medical use of selected pharmaceuticals since 2004.

This stunning fact has been ignored, obscured, or un-reported, in the latest media frenzy to create fear and hysteria in the public, about prescription drugs. The reason is clear - it undercuts the propaganda about the "epidemic" of prescription drug overdoses in America.

In fact, of the 1.6 million ED visits for the abuse and misuse of drugs in 2004, and the 2.0 million such visits in 2008, illicit drugs such as cocaine and heroin were involved in 1 million visits in both 2004 and 2008. The estimated number of ED visits involving the non-medical use of opioid analgesics increased from 144,000 in 2004 to 305,000 in 2008, an increase in rate from 49.4/100,000 to 100.6/100,000 in 2008. The number of overdoses, even increased from 2004 to 2008, represent a statistically tiny and insignificant number, compared to the hundreds of millions of doses of prescriptive medications ingested annually, and safely.

The essential fact is that the abuse of prescriptive drugs has NOT increased in the general population. Rather, what has increased is the abuse and overdose of prescriptive medications by an aberrant and atypical cohort amongst the general public, and the extensive and flamboyant coverage in the media this group has gotten. The media, encouraged by selected federal agencies, has then falsely extrapolated the aberrant phenomenon to the general population. The plain truth is that, despite the large increase in prescribing of analgesic medications over the last four years, there has been NO increase in the rates of non-medical use of selected pharmaceuticals.

The governmental campaign to reduce the availability of prescriptive pharmaceuticals is without validity or value. If implanted, it will simply make it more difficult for patients to obtain the medications for which they have a medical necessity, it will only further deter physicians from prescribing "unpopular" and "demonized" medications, it will further confuse and mislead the public about prescriptive medicines, and it will have no impact, whatever, on the core group of atypical and aberrant abusers of prescriptive and illicit drugs.

In sharp contrast to "Drug War" propaganda, it would be far more valuable to focus attention, funding and resources on identifying the aberrant group who present a mortal risk to themselves, educating the public on the need to provide them effective intervention and medical help, and reduce the pathology that underlies their increased rates of harm to themselves. In that regard, it is not clear to what extent this group is increasing as psychologically damaged military veterans return to civilian life, bringing their substance abuse symptoms and suicidality with them.

J.S. Hochman MD
Executive Director
The National Foundation for the Treatment of Pain
www.paincare.org

J. S. Hochman MD

to Jared, Barry, Barbara, bettina, billy.neel, Brett, batlas, Brian, Brigette, Donny, Taylor, capthill, Carey, Cathy, Don, Bob, edye, paul, Gene, Gina, iand14, Jeffrey, joseph, Joyce, karen, Kelly

In response to the link, below, to a video Jared circulated of a really "pissed off" guy:

https://mail.google.com/mail/?ui=2&ik=c7e3742ffb&view=att&th=12a25c8dec6d8467&attid=0.1&disp=attd&zw

Jared:

I am convinced that this kind of scree fits right into the "smoke and mirrors" that keep us all from focusing on the real issues. The real problem is that the United States has become a nightmare of political corruption that involves virtually every politician, state and federal, and the labels "Democrat" and "Republican" are just red herring distractions. Likewise, the labels "liberal" and "conservative" are meaningless distractions.

* What is "liberal" about a tax code that is 80,000 pages long now, in order to accommodate the special privileges that individuals and corporations have bought from politicians since the 22nd amendment eliminated the Constitutional restriction that allowed a federal tax on individuals only "if based on a census" (i.e. divide the cost of government by the total number of citizens).

* On the other hand, what is "conservative" about a two-term president who spent the nation into bankruptcy on a Middle Eastern war that has now lasted longer than Vietnam, killed a million people, and is unwinable?(What is "conservative" about who got all the money we've thrown away on it?)

* What is "conservative" about bailing out banks and insurance companies that had cheated and swindled their way to profits in the hundreds of billions, and allowing them to PROFIT by the hundreds of billions in the bailout?

* What is "conservative" about jailing a million and a half people in federal prisons for non-violent drug crimes (at a cost of $68,000 a year per inmate at privatized prisons owned by politicians and their fellow-travelers) when the infrastructure of the nation is falling apart, most importantly public education, and highways, bridges, power grids, water systems, etc.?

* What is "conservative" about the fact that 1 out of 51 people were on federal probation or parole in 1985 and the figure is now 1 out of 12? What is "conservative" about the fact that America is the only developed nation in the world that murders its citizens and calls it legal because 500 pounds of legal paper sanitize the act?

* What is "conservative" about a nation that permits a true tax rate of almost 51% (Holland's is 50%) (including income tax, sales tax, state income taxes, inheritance taxes, property taxes, etc, etc) and unlike Holland, which provides every conceivable kind of assistance to its citizens from birth to death, gives its citizens NOTHING?

It is not an issue of right or left, black, Hispanic or white, it is an issue of criminal exploitation of every person in the country by the less than 3% of the population who own 98% of the wealth and control a totally corrupted Congress and Executive branch through political "contributions".

* On that subject, when we were trying to legislate reform in our health care (ranked number 46 in the world, right behind Albania) insurance and pharmaceutical corporations spent $500,000 a DAY, that's $1000 a day on every member of Congress, controlling the outcome of the Health Care Reform Act. (The Act states that 80% of premium income must be spent on health care. Now the insurance company lobbyists are fighting to control how that is defined - so that their corporate aircraft, $100,000,000 a year CEO salaries, Board junkets to Monaco, etc., can be defined as "part of health care". Part of how they want to define health care is also the hundreds of millions they spend controlling what doctors can prescribe and how they can treat, their patients.


As long as the mega rich and the media they own can keep the American public "pissed off" about everything EXCEPT the REAL issues, nothing will change in this country for the average person who pays ALL the taxes. The founders of the American republic are spinning in their graves like gas turbines. For God's sake we had a revolution over a tax on tea! What would they think about America now? The Oligarchs of Wall Street and all their moneyed co-conspirators make King George the III look like Mother Theresa.

It is NOT about how many illegal Mexicans have smuggled their way into the United States to escape the drug war in Mexico and the grinding poverty the Mexican Oligarchs have kept them in since the Maya farmed them for food. It is NOT about how many guns you can own. It is NOT about corrupting the whole focus of education into passing meaningless tests that are supposed to create "accountability". It is NOT about piling laws and regulations on top of laws and regulations to keep 8,000 whacked out people from killing themselves every year with illicitly obtained prescriptive drugs. It is NOT about whether white people are threatened by the growth of minorities in this country. It is about everyone, white, black, brown, yellow, red, any color, being degraded into serfs as powerless as those of the middle ages.

The history of Mankind is a nightmare of exploitation of our own. What we have now is that same nightmare souped up by the information age, megabucks, instant communication, the ability to track every individual in the world constantly, and the complete distraction and bamboozlement of the American people from this reality.

Your friend in the video is definitely pissed of. But he hasn't a clue about what he is REALLY pissed off about. He's too busy listening to Rush Limbaugh and the other phonies and hucksters who have made themselves millionaires pandering to the big boys, and exploiting the rage of the little guys, as they distract their listeners from reality.

If you want to really get something done, tell everyone you know to wake up.
All this conservative-liberal, Democrat-Republican stuff is gossamer bullshit.
Joel

"When Pain Drugs Hurt" - According to Whom?

August 2, 2010

To The Editor
The New York Times
Re: “When Drugs Hurt”

It is roundly accepted that approximately 26% of the population suffers from chronic pain. Inadequately treated pain commonly results in the destruction of lives – bed-ridden, unable to function, cut off from family, friends and society. It is a living nightmare for the victims. Virtually every chronic illness will result in chronic pain. And virtually every person will confront this during his or her lifetime.

Chronic pain, when adequately treated, can virtually always be controlled. Tragically, however, few physicians have the experience, training or confidence to prescribe adequately. Paradoxically, when confronted with the failure of their inadequate treatment, pain “specialists” (most often anesthesia-trained “interventionalists” who prefer remunerative procedures over cost-efficient prescribing) rationalize their inadequate dosing with various chimera. They hypothesize patient non-responsiveness, or hyperalgesia (a mythical syndrome in which the patients develop increased pain in response to the pain medications), or demonize the patients as non-compliant, drug-seeking or addicted, when the simple truth is that they have failed to prescribe adequately.

Adequately treated pain patients blossom – they regain the quality of their lives and consider their treatment to be “miraculous”. They suffer no complications, adverse effects, impairment of cognition, or the induction of any form of addictive disorder. They do become physiologically dependent, just as a diabetic would upon insulin or a cardiac patient upon digitalis – sudden discontinuation of their medication will result in definite withdrawal symptoms. Compliant and legitimate pain patients virtually never suffer overdoses. But pain patients must often travel hundreds, if not thousands, of miles to find a physician with the expertise and training to treat them adequately, and most state medical boards, although paying lip service to supporting pain care, intimidate physicians so consistently that few doctors are willing to undertake pain treatment (just ask your private medical doctor if he is willing to write a schedule II prescription.)

The current campaign to reverse the progress of pain management in the last decade (a 30% increase in prescribing) is driven by a resurgence of “opiophobia” (see the original article in 1984 by John P. Morgan MD); by the attempt of interventionalists to corner and control the pain treatment market; by the attempt of insurers to escape or extremely limit the costs of treatment; by addiction treatment mavens who want to label all opioid using patients as candidates for their services; and by “drug warriors”, who having totally failed to solve any illicit-drug related problems after a trillion dollars of income, now seek to continue their gravy-train by redirecting the tabloid-driven hysteria about drugs to the prescriptive side. The drug war is a total scam and the perpetrators can be simply identified by noting where the trillion dollars went.

The current media-supported propaganda is based upon the “epidemic of overdoses” over the last five years. Two facts are neglected in these breathless articles. First, federal surveys over the last four years show that drug us in America has actually decreased . Second, although Emergency Room visits doubled and there were 8,000 deaths in the last three years from drug overdoses, none of the deceased were pain patients. or "little old ladies" from the general public There were over 50 million doses of OxyContin consumed last year. How do 8,000 crazy abusers killing themselves compare to the good done for the majority millions? It is not ‘little old ladies with arthritis” as claimed by Dr. Cahana, but reckless drug-abusers, most often combining illicitly obtained opioids with alcohol, benzodiazepines and many other drugs. The millions of little old ladies with arthritis cannot even FIND a doctor willing to prescribe, so they remain crippled and denied.

Analysis of the actual data cited by the hystericals and the political fellow-travelers reveals that the use of opioids has increased significantly without statistically significant harm. The harm cited in your article is not to legitimate patients, but to abusers who, apparently driven by “natural selection”, relentlessly find ways to take themselves out of the genetic pool.

What is needed is to require every physician to become expert in the ADEQUATE treatment of pain, compel them to treat ALL legitimate pain sufferers, and to provide adequately funded treatment for every person (a tiny percentage of the whole) who suffers an addictive disorder, or who reveals their compulsion to abuse prescriptive or illicitly obtained drugs by overdosing.

The current tabloid campaign is simply an attempt to resuscitate Opiophobia – throwing the baby out with the bathwater – by a conspiracy of the misguided, the self-interested, insurers, the ideologues and the trillion-dollar enriched scam artists behind the war on drugs - now trying to morph into the war on doctors and legitimate pain patients.

J.S. Hochman MD
Executive Director
The National Foundation for the Treatment of Pain
www.paincare.org
1714 Whoite Oak Drive
Houston, Texas 77009
713 982-9332

Dr. Petersohn of Philadelphia

Sirs:

If you are the idealists you aspire to be, GIVE the software to your colleagues for a single nominal fee which reflects the cost of developing the product. Charging a monthly fee is a scummy ploy to regularly extract money playing on the fears of physicians who keep poor records, maintain a dubious standard of opiate prescribing, and routinely use industrial strength controlled substances because they are not fully trained pain docs or because they have realized how much money they can make writing controlled substance medications with little or no medical basis as opposed to the hard work that is legitimate medical practice. These practices are no better than the epidural injection or trigger point patient mills favored by ambulance chasing attorneys. If we succumb to these poor practices, we are little better than used car salespeople or politicians.

Offering single-modality treatment with opiates by prescription to the majority of patients in any practice, even a pain practice, is the modern version of "Tea and sympathy," and a highly suspect strategy employed in desperation to provide a simple (but ineffective and inappropriate) solution to a complex problem because the physician, however well-intentioned, lacks the skills and knowledge to evaluate and resolve the underlying problem. Yes, perfect interventional and rehab solutions do not exist for all problems, but most patients who benefit from erudite professional care.

We all know that opiate outcomes are mediocre overall, seldom resulting in improved patient function over years or allowing return to work, etc. The data simply do not support opiophile practice, yet the opiate industry supports groups, like the American Pain Society and the American Academy of Pain Management, yes, and also the throw-away "journals" which espouse opiate medications and oppose interventional treatment. Hard to trust these organizations, in that interventional treatment is based on clearly defined principles of anatomy, neurology, physiology, neurosurgery and orthopedics which have superior outcomes with robust literature support.

As an organization, you will likely go broke defending the practices of the many physicians who charge $100-120 per patient office visit for writing Rx opiates without REAL medical indications. I have seen at least three physicians taken out of practice in my county in the past year and all of them truly deserved to be forcibly retired from their suspect practices, yet more of these fellows remain in their offices, writing Rx's and watching their cash registers ring. These docs should be closed down and the DEA and State Police should be watching these practices closely. While you espouse a noble cause, we must see how noble you are by your standards and your actions or disappointingly, if you are just another group of get-rich-quick schemers. I hope you are the former.

Jeffrey D. Petersohn, M.D
Adjunct Associate Professor
Department of Anesthesiology
Drexel University School of Medicine
Philadelphia, PA
-------------------------------------------------------------------------------------


Dear Dr. Petersohn:

I have practiced the medical management of chronic pain for almost 20 years now. I have a paper in draft for submission for peer review that reports the results of following a universal sample of 204 patients (every consecutive pain patient enrolled in treatment) for ten years. The paper reports the regimen, the doses and schedules, the pain levels, the functionality, adverse consequences (including aberrant behaviors), range of motion and patient and family reports on outcome.

The medical management of pain is bi-phasic. The first phase, after review of history, initial evaluation, affirmation or determination of diagnoses and construction of a plan of treatment, is titration to effective pain control. In conformity with all Standards of Care, dosage and schedule of opioids is entirely individualized, with no restrictions by pre-conceived notions of "maximum" doses.

The second phase is long-term , almost totally stable (pathology does increase in some cases, requiring occasional [but relatively few] adjustments in medication. Virtually every patient in the study achieved remarkable improvements in pain levels, functionality, range of motion (often more than 20"), family confirmation of improvement, with VERY few incidents of aberrance. No overdoses occurred. A few patients were terminated for non-compliance, often determined by urine testing for compliance or obvious "red-flag" events.

If you believe that long-term opiate management is rarely successful it is most likely the consequence opiophobic
under-treatment.
Regarding the PPLA, the offer of electronic medical record keeping is not an activity owned by PPLA. It is an outside source through Medical Office Online. I myself pay the monthly fee (from which PPLA receives NO benefit), which I find to be not only very helpful in maintaining my medical records in compliance with the looming EMR requirements under the Health care Reform Act, but also very inexpensive in comparison with on site hardware and software alternatives.

We share with you your disdain for "Pill Mill" pain treatment. But we do not demonize these operations. They are obviously a free-market response to the millions of blue-collar pain patients who are un or under-insured, and for whom $100 a month is a lot of money. The "War" on these clinics is actually a "War" on blue-collar pain patients (see my blog entry on this subject at www.jfshmd.blogspot.com). Relatively few of the hundreds of patients who attend these clinics are criminals. But the authorities, seeking to maintain the anti-drug hysteria that has directed a trillion dollars of funding into their pockets over the last 20 years, have shifted from anti-illicit drugs (a total failure) to prescription drugs, as a self-serving propaganda campaign to continue their gravy train.

I personally also decry the Intervention-mills, where, as Perry Fine mentioned to me recently, "the only requirement for utilizing procedures is an insurance policy." Interventionalism" has become just another money-making scheme, unimpeded by any scientifically defensible outcome data, which strongly requires the construction of Standards of Care and decision-tree criteria, with robust outcome studies.

We have spent five years bringing PPLA to the medical profession, to encourage the legitimate and effective treatment of millions of unnecessarily crippled patients. Opiophobia, and the fear of regulatory catastrophe, stand in the way of that goal. PPLA provides a state of the art Standard of Care and Record-keeping, the services of a panel of pain-management "luminaries" to provide expert consultation and legal defense expertise, highly accomplished legal consultants to guide legal defenses where necessary, inexpensive EMR, and up to $500,000 of legal defense (to prevent the bankrupting of legitimate doctors.) No practitioner-member of PPLA who practices below the Standard of Care will meet the criteria for being defended.

We urge that you join, and if you are so inclined, join our Professional Advisory and Review committee (along with Perry, Sharon Weinstein, Stratton Hill, Steven Simons, Joe Pergolizzi, and ten others.) And I urge you, before you go off on something about which you clearly had done little exploration, to do your homework first.

J.S. Hochman MD

Phony statistics, Fear-mongering and the Drug War Swindle

See the article from Time Magazine, below.

Experts in the field have known for a long time that claims that deaths were caused by opioids are supported by blood level data that is unreliable. Opioid blood levels in chronic pain patients are not in any way comparable to those in opioid naive patients. Toxicological "standards" typically used by coroners are inappropriately based on naive patients. Clearly prosecutors have no interest in science, except to distort it to win convictions.

Further, the media fails to distinguish the difference between "occurrence" and "incidence".The claim that opioid overdoses have "tripled" in the last decade disregard the fact that the prescription of opioids for pain has increased by approximately the same proportion. Further, when one compares the number of overdose deaths claimed for OxyContin - 8,000 in 2009 - to the total number of doses of OxyContin prescribed - about 50 million - the INCIDENCE of overdose deaths is statistically insignificant (in fact, trivial.) Further, most of these deaths occurred in the presence of alcohol and many other drugs, ingested by crazies, not patients.

The War on Drugs, and it's subsidiary, the War on Pain Patients and Doctors, is not only a catastrophic failure, at the cost of almost a Trillion dollars, but is also a gigantic swindle. Playing upon the fears of a naive public, and the lack of rational and critical thinking, a whole "Drug War" industry has profited enormously. A simple analysis of where all this money has gone will reveal who the swindlers are.

Hopefully that data will be emerging in due course, as the nation wakes up to the crimes of the "Drug War"
J.S.Hochman MD
Executive Director
NFTP
----------------------------------------------

In a case in Wichita, Kansas which has garnered national attention, Dr. Stephen Schneider and his wife, Linda, the local doctor-and-nurse team are accused of running a large-scale "pill mill" and dispensing prescriptions that led to the drug-related deaths of 68 patients. Prosecutors allege that the Schneiders illegally prescribed large amounts of powerful painkillers for profit, with little regard for patients' safety. The defense, along with some former patients, argue the Schneiders provided sound and compassionate care, and that the deaths were due to underlying conditions or dangerous choices by addicted patients.

The couple's trial, which has been ongoing since April, has once again shed light on the increasingly sensitive issue of prescribing high doses of opioid medications for pain. Opioids (drugs such as fentanyl, oxycodone and hydrocodone, which the Schneiders prescribed), which are crucial for the welfare of pain patients, especially at the end of life, are unfortunately better recognized as addictive drugs associated with overdose death.(See Ledger, Heath.) And although the popular perception of these substances is in many ways misguided, cases like the Schneiders' highlight the dangers of prescription-drug misuse.(See the top 10 medical breakthroughs of 2009.)

But the case has also highlighted the difficulty of accurately determining if a cause of death is indeed a drug overdose. With the rate of prescription-drug-related overdose deaths more than tripling in the U.S. since 1999, according to the Centers for Disease Control and Prevention — and with physicians sometimes being prosecuted for contributing to these deaths — it is the courts, not physicians, that are increasingly forced to make judgments about drug-users' real cause of death.

Unfortunately, the mechanics of that determination are poorly understood — sometimes even by the toxicologists, pathologists and medical examiners who make the call. Circumstances of death surrounding drug use are also often difficult to untangle: In the Schneider case, virtually all the patients who died were found to have multiple drugs in their bloodstream, often including illegal drugs; in addition, many of the patients were known sufferers of chronic pain with chronic, life-threatening diseases such as heart disease and high blood pressure — conditions that can cause death on their own, without drugs.
Much of what scientists do know about drug-related death comes from the 25 years of research by Dr. Steven Karch, a cardiac pathologist based in Berkeley, Calif., who has written two widely respected texts on the topic. On June 7, he testified for the defense in the Wichita case, stating that in most instances of drug overdose, the currently available medical technology cannot accurately determine whether or which drugs caused death.(See how people get addicted.)

Several scientific factors conspire to complicate the issue: First is the widely acknowledged question of tolerance. Patients who take pain medications over the long-term will necessarily build up some amount of tolerance to the drugs. That means that a dosage of a painkilling opioid such as methadone or fentanyl that would be therapeutically appropriate for a pain patient could be enough to kill a person who has never taken them before; in a methadone patient, an extremely high dose might not even be enough to address withdrawal symptoms.

In other words, Karch says, the "lethal dose" of these drugs is impossible to standardize, even for patients who are taking a single drug rather than a combination of many. A 2000 study by Karch compared methadone patients who had died from clear causes, such as car accidents, with those who had died of a suspected overdose. Karch found that there was no predictable difference in the postmortem blood levels of methadone between the two groups. In fact some of the patients who died of other causes had higher levels of methadone in their bodies than those thought to have overdosed. "You can die from a drug and you can die with a drug," says Karch. "When you have four orders of magnitude separating either end of the curve, many of these deaths may not have to do with drugs at all."

At least one forensic tool helps clarify the question in some cases, according to Karch. In 1999, Karch testified on behalf of the prosecution in a case against a British physician who was convicted of killing 15 patients by injecting them with heroin (a legal painkiller in the U.K.) and is suspected of having killed hundreds of others. By analyzing hair samples, which can record an individual's history of drug use, Karch was able to show that the patients were not prior drug users and were, therefore, almost certainly killed by the drugs the doctor administered. This technology, which can cost thousands of dollars per analysis, was not used in the Schneider case, during which the medical examiner testified that a person's drug history is "not something that I usually consider or go into" when drugs are detected in the body and no other cause of death is apparent.

A second complication in cause-of-death findings is what medical examiners call "postmortem redistribution," the shift in detectable drug levels that occurs after a person dies, according to Fred Apple, medical director of clinical laboratories for the Hennepin County Medical Center in Minnesota. Many drugs that may be contained in fatty tissue in a living body are released into bodily fluids after death, which confuses the analysis of substance samples taken postmortem.

In a study published in March in the American Journal of Clinical Pathology, Apple and colleagues measured fentanyl levels in bodies immediately after death and again several hours later at autopsy. The researchers found that some bodies had no detectable levels of the drug at the first measurement but showed significant levels at the second — and that these levels varied widely depending on which part of the body was sampled. Since it is not always clear when exactly a person died, or how long redistribution takes, the variance could make a therapeutic level of a drug appear toxic, or vice versa.

What is clear, however, is that juries across the country are in some cases hearing evidence based on shaky forensic science or from forensics professionals who lack the necessary expertise. According to a 2009 report by the National Research Council of the National Academy of Sciences: "Rigorous and mandatory certification programs for forensic scientists are currently lacking...as are strong standards and protocols for analyzing and reporting on evidence. And there is a dearth of peer-reviewed, published studies establishing the scientific bases and reliability of many forensic methods. Moreover, many forensic science labs are underfunded, understaffed, and have no effective oversight."

Given the state of the science, then, should it be used in court? Ed Cheng, a professor of law at Brooklyn Law School and expert on scientific testimony, says, yes, noting that more research is still needed. "If we were to require studies and statistical assessment on every assertion, almost nothing would be able to be used in court. My view on this is that the question here is not throwing the baby out with the bathwater," says Cheng. "It's clear that the forensic sciences do not have as much of an empirical basis as we would like them to have. The question becomes how do we motivate them sufficiently to come up with the empirical basis that we want?"

Some experts do agree with Cheng. "The evidence base is improving," says Apple, who is currently conducting a study of blood and tissue samples taken postmortem, in order to build up a usable database of drug information. "So when people have to make death determinations from smaller jurisdictions where they don't have [an expert on staff] like me, they can make them with some assurance."

But Karch is less sanguine about the reliability of such data and thinks that as long as the reliability of forensic evidence is still evolving, it has no place in court. "It's a giant miscarriage of justice," he says. He recalls the malpractice and murder convictions that were won many years ago against doctors who were thought to have killed patients by administering digoxin, a drug for arrhythmia and other heart problems. It turned out that the drug collected in the heart muscle in live patients and was released into the body after death, making safe doses of the drug look deceptively high — a result similar to those seen in current studies of fentanyl and methadone.

In the Schneider case, which entered jury deliberations on Wednesday, the defense team sought and failed to prevent the jury from hearing testimony that it believed did not have sufficient scientific foundations. But according to Cheng, it may be preferable to let the jury hear both sides of the scientific dispute and make up their own minds. "I myself have floated between the poles on this," he says. "I'm currently more on the 'Let the jury hear it' side. I'm not convinced that good science and bad science is always cut and dried."

Read more: http://www.time.com/time/health/article/0,8599,1996831,00.html?xid=rss-%20topstories#ixzz0tqsBnxR5
-----------------------------------------------------------

The Schneiders were convicted - two more casualties in the Phony War. Of course, it isn't phony to them, as their lives have been destroyed. Hopefully in time the wheels of Justice, grinding exceedingly fine (but horrendously slowly) will undo this travesty.

The Intertventionalists' Fraud (Florida, Texas, Louisiana)

Contact: Paul Sloan
pas401@gmail.com

PAIN CLINICS: GRAND JURY REPORT DECEPTIVE

Special Report Uncovers Omissions, Misrepresentations, and Deception in the
Interim Report of the Broward County Grand Jury (Venice, Florida: July 15, 2010)—

A thirty one page research report released today by the Florida Society of Pain Management Providers, available online at www.FLPainNews.com, challenges many of the purported factual findings of the Broward County Florida Grand Jury Report on Pain Clinics (released on November 19, 2009). The result is a document which is factually deceptive and what is left contains far more innuendo than fact.

The Grand Jury, convened in the spring of 2009 by Michael J. Satz, State Attorney for the Seventeenth Judicial Circuit, to study the “proliferation of pain clinics in South Florida” was substantially influenced by special interest groups. The purpose of these groups appears to have been to influence legislation and governmental agencies in the development of rules that would regulate their field. The testimony by these special interests groups went un-researched and unchallenged by the State Attorney.

The research report details how the “The Grand Jury Report is ultimately an embarrassment of monumental proportions because of the slanted, biased, and misleading testimony by “pain medicine specialists” and the complete lack of any law enforcement data or statistics,” says Paul Sloan, Director, of Florida Society of Pain Management Providers and author of a special report, entitled, The Omissions, Misrepresentations, and Deceptions as Reported in the Interim Report of the Broward County Grand Jury, says, “In many cases, what the report states as facts, are in most cases anything but. This Grand Jury reports becomes just another example of why most jurisdictions in the United State have abolished this medieval process.”

The special report, compiled and submitted by Paul Sloan began as research for a series of submissions to the Florida Board of Medicine and Osteopathic Medicine when those boards were conducting rules workshops for pain clinics. Mr. Sloan noticed that the assertions being cited by two professional medical societies with mutual members and interests were not based on any known facts. A review of the testimony and the assertions that found their way into the grand jury report evidenced a well organized and orchestrated scheme to influence both the workshops and legislation. The desired effect: create a monopoly in their specialty field. It is Mr. Sloan’s belief that what was most dishonorable is that this was all done under a guise of concern over the accidental death rate related to the diversion of pharmaceutical medications.

Members of the Florida Society of Anesthesiologists (FSA) and the Florida Society of Interventional Pain Physicians (FSIPP) have attended the joint medical board’s workshops in great numbers and have spoken directly to their desire to eliminate non board certified pain medicine physicians from the specialty field. As evidenced in the special report, it was recently revealed that these societies’ members (some in public positions) have also been manipulating county zoning ordinances to drive out non board certified physicians.

These actions are concerning on both ethical and legal grounds. One of the findings, which was recently uncovered by Mr. Sloan, contrary to nearly all testimony on the subject, is that there are only 204 board certified pain physicians currently practicing in the State of Florida.

The societies desire to drive out all others from this field, if successful, will be at the expense and detriment to the 18,500,000 citizens especially the uninsured and under insured (Medicaid) whose access to pain care will be severely restricted. There are no board certified pain physicians in 31of the 67 counties in Florida and in fact there is just 1 boarded certified pain physician for every 91,765 residents. This puts Florida into the same category as some 3rd world countries. According to Mr. Sloan, currently in South Florida, alone, there are 13 contiguous counties covering 12,000 sq miles with a population in excess of 5,000,000 without a board certified “pain specialist” to treat Medicaid patients.

It is unfortunate that many well educated and respected individuals believe that Grand Juries are a legitimate and ethical institution and in return accept their reports as the unquestionable fact when in fact they are easily manipulated in order to reach a predetermined outcome.

The Special Report is available online as www.FLPainNews.com For more information e-mail Mr. Sloan at pas401@gmail.com
--------------------------------------------
NFTP previously commented on the current assault on "Pill Mills",

http://www.blogger.com/post-edit.g?blogID=4271454310269129358&postID=6364312137204145508

pointing out that it is actually an assault on blue-collar pain patients. With this news release the REAL source of this unconscionable campaign is revealed.

I am ashamed of any physician who would participate in such craven self-interest. But, this is what is happening. Drug "warriors", of course, are happy to go along, as it serves their self-interests (perpetuation of the fruitless and counter-productive waste of a trillion dollars in the last two decades, from which they have profited extraordinarily.)

When will the American public wake up to this swindle?
J.S. Hochman MD