Map of life expectancy at birth from Global Education Project.

Tuesday, June 19, 2007

This and that

1) Readers may be interested in this from Michael Moore's publicists. No skin off my nose to post it:

To raise awareness of the increasing American healthcare issues and the film, we have created an official SiCKO YouTube group ( Michael wants YouTube members to share your Healthcare Horror Stories and tell us about an experience you had with your insurance companies or healthcare providers. This is the group where you can post your videos to share with Michael, who will be screening them and sharing them with Congress. This is a platform to be heard - so make sure to encourage your readers to upload their own videos today!

2) Our friend Lisa Ann Wright asked me to comment on her post about about the prosecution of Dr. William Hurwitz for what the DA considered to be unlawful prescription of narcotics. I don't know anything about this specific case, but I did offer Lisa Ann these more general thoughts.

Physicians have to make judgments all the time about prescribing narcotics; sometimes these judgments are quite difficult and they get into gray areas of legality as well as ethics. For example, I interviewed a man with HIV who said he had agreed to accept a prescription for antiretroviral medication in exchange for a prescription for morphine. He was a junkie, but was the physician wrong? She was trying to save his life. If she didn't prescribe the morphine, he would have bought heroin on the street. This way, he lived in the YMCA, didn't commit crimes, took his meds, and took his morphine. So what's wrong with that? But a prosecutor might find it indictable.

It is perfectly legal to prescribe opioids to addicts if they happen to be methadone or buprenorphine, although these drugs can be prescribed only under strictly controlled circumstances. Drugs that are in fact more subject to abuse, such as hydromorphone and oxycodone, can be freely prescribed, but as Dr. Hurwitz learned, you can also get in trouble for it. Sometimes patients (like Rush Limbaugh) deceive physicians in order to get multiple prescriptions or continue to get scrips when they are no longer really in pain. Sometimes people with legal prescriptions supplement them with street drugs. Expecting physicians to know everything their patients are doing and to police them is unrealistic. Treating them as criminals for making what some people might construe as errors in judgment, or simply different judgments than some others might make, or being victims of deception is clearly counterproductive.

That said, it is certainly possible for a physician to cross far enough over the line that the issues are no longer ambiguous. I would say there would have to be corruption for money involved, first of all, not an honest judgment about what is in the best interest of a patient. It would have to be ongoing and the physician's guilty knowledge would have to be demonstrable beyond a reasonable doubt, of course.

The situation would be less fraught and easier to make effective policy around if narcotic abuse was decriminalized. By the way, there is a similar and somewhat better known case, that of Dr. Ronald McIver, who is currently serving 30 years in prison for actions which were clearly taken in what he believed to be the best interests of his patients. His case is discussed by Aspazia, here.

This crusade against physicians who are trying to help suffering people is just one more example of how "moral values" in this country have become a synonym for evil.

3)And while we're on the subject of moral values, God's anointed representative on earth wants to provide just $4.8 billion in new funding for the Supplemental Children's Health Insurance Program over the next five years. The CBO calculates that will purge 1.4 million children from the roles -- and 6 million eligible children are already uncovered because the existing money doesn't stretch far enough. That's according to the Congressional Budget Office. Of course, the administration, with its usual disdain for the reality based community, claims the true number is only 794,000. Advocates want to put in $50 billion over the next five years -- $10 billion a year -- and cover all the children. So the difference is $5 billion a year -- enough to fund the occupation of Iraq for a couple of weeks. But we know which of these is a higher priority for Jesus. Just ask the Christian Coalition. (Bob Herbert discusses S-Chip in his column today but the NYT won't let you read it without paying. So no link.)

Update:Lisa Ann hips me that you can get the Herbert column free for 24 hours, here.

1 comment:

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