| 21 January 2006 Pain Killers I’m not going to negotiate with terrorists. That is my policy, and I am going to stick to it today. I wavered yesterday, muttering under my breath that I would put the whole policy up for review as the Acela train hurtled down the tracks toward Washington. Just not this train, not today. If someone decided to mess with it, it would be in the final miles, I thought, some dramatic act of martyrdom that would include the rest of us going home. It was a chilling thought. The train would plow into Union Station at high speed, the sleek engine jumping the platform and dragging the cars and us unwilling martyrs behind it into the vast hall of the public waiting room, and maybe out the other side into a silver heap in front of the Senate side of the Capitol Dome. As it happened, nothing happened. My resolve stiffened once more on the long cab ride home through the rush hour traffic. No negotiations, I thought. None. When I was sorting the bills at Big PInk later, I noted that there was no word on the fate of the hostage who was supposed to have ben killed the day before. Ambiguous situation; the plucky little Christian Science Monitor corespondent was out there on her own. Maybe she was dead already. If she had been released, it would have been news. I read a copy of the local Washington alternative weekly on the trip. It is nice to read the news from someone else’s perspective, which is why I like the BBC, which attempts to balance equally the interests of people in Burkino-Faso and Washington in their programming. In the letters column someone was complaining bitterly about the Drug Enforcement Administration. I read with some interest, since I had the opportunity to meet the Director of that agency recently, and wondered what it would be like to have a badge and join the War on Drugs. Her name is Karen Tandy, and she is one of those women with a great public presence. She had a self-depreciating manner when she spoke, which must have been useful when she was a prosecutor, winking to the jury that they were all on the same side. I talked to her after the talk, and was impressed by her energy and presence. So I was a little surprised to find that her agency is propagating some very strange policy. Apparently the DEA has not gotten that word that the medical profession has changed position on the issue of pain. Since the beginning of the last century a battle raged about treatment of patient discomfort. The patent remedies that were freely sold before the introduction of the Pure Food and Drug Act contained all manner of substances, normally added to some sort of dark vegetable extract. The were laced with ample doses of alcohol, even as cough medicine is today, with the bonus fortification of morphine and opium. "Foley's Honey & Tar for Coughs and Colds" was typical of the breed, and I like the name. I don’t know if any of my ancestors had a role in concocting the remedy in a back room someplace, but it was one of the first casualties of Theodore Roosevelt’s Pure Food and Drug Act. I support what he did, since practices in the food industry, particularly the beef sector, are enough to make you sick just reading about it. People were not going to stop eating cattle, though, and the first casualty of this legislation was the patent medicine industry. The initial legislation was strengthened in 1911, when additional provisions were added to combat fraudulent labeling. Coca-Cola, for example, apparently contained a little Cocaine for that special jolt. After 1911, they had to go with caffein like everyone else. The elimination of patent medicines revealed one of the dynamics of the American psyche, that strain of virulent Puritanism that glories in sacrifice and elevates suffering as a demonstration of godliness. There is, of course, a parallel American strain that exults in excess, and the dynamic tension between the two could be reduced, in shorthand, to the Red and Blue divisions in the body politic today. The great War on Drugs, which is another of those generational struggles continues. There appears to have been a cease-fire in the War on Poverty, which was as optimistic, if delightful wrong-headed, as anything that Washington has tried to do. But with the War on Terror, the War on Other People Having a Good Time seems to have an indefinite future. I remember the topic coming up in a seminar at War College. Our seminar of senior military and Government officials was, by definition, a fairly conservative group. But the topic split us right down the middle. Half the group, mostly pragmatists, were of the opinion that drugs should be legalized, regulated, taxed and distributed under Government control. This would, reasoned the pragmatists, remove the incentive for smuggling, cut crime, and curtail the inexorable financing of renegade Narco-states which feed on the insatiable demand here in the United States. The other half of the class said drugs were wrong, and the fight had to go on, damn the consequences, because it was wrong. It was Red State and Blue State, plain as day. The same sort of battle was being fought out in the halls of medicine. Pain should be held at bay, went the thought, but not too far. A certain degree of pain was considered necessary to the human experience, and the amount of painkillers prescribed were always a little less than the duration of the pain itself. At least that was my experience. The position appeared to change over time, and the last time I had surgery, the pain medication was sufficient to meet the need. A standard of pain was established, 1-10 on a scale of increasing agony, and drugs were prescribed based on the patient’s perception of pain, rather than the doctor’s estimate. I imagine that system is subject to abuse, but I think I prefer to err on the side of comfort. The hospice movement, in which terminal patients are made to feel comfortable, was accepted as a rational and humane part of the medical art. So I was surprised that with everything else going on, Karen has permitted her agency to insert itself into the medical ethics business. The DEA has launched investigations into the prescription of painkillers like OxyContin, on the grounds that they might be sold on the streets. Apparently the torrent of unregulated raw drugs flowing from Columbia and Afghanistan are not problem enough, or the proliferation of crystal methadrine labs across the country. Resources must be allocated to examining the practice of licensed physicians, without regard to whether prescriptions are based on a medical opinion, and whether or not there is evidence that there is proven intent for the drugs to be resold for recreational or other uses. It doesn't even matter if the patient is in pain. I was briefly in the public health bureaucracy, and was always curious about how non-medical people made medical decisions. The DEA has no dedicated medical staff, but they have gone ahead and established what they consider a level of "legitimate medical purpose." They are prosecuting doctors and sending them to jail for exceeding what the Agency considers reasonable practices. There might be an abuse of medical procedure going on out there. My only question is, how would they know? Copyright 2006 Vic Socotra |