Blogs > Liberty and Power > U.S. Government to American People: Suffer

Apr 26, 2006 10:13 am

U.S. Government to American People: Suffer

Each and every one of us is at risk of experiencing severe chronic pain due to accident or illness. If that time comes respite from that pain will become the most important objective in our lives. An absolutely excellent and comprehensive article in the Spring issue of The Independent Review by Ronald T. Libby shows how our government is actively seeking to deny us the relief we will need. I have posted some highlights from the article at The Trebach Report.

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Keith Halderman - 5/4/2006

That is a very good point. I do not know if Dr. Hurwitz's prices were too high, however I do know that among the most distraught people over his arrest were his patients who feared a life of severe and constant pain. What our friend Mr. Clark fails to acknowledge is that this mindless quest to stamp out drug addiction has quite unacceptable consequences for many individuals. Let us remember that the idea that it is not valid medical practice to prescribe drugs to maintain addiction is the historical product of bureaucratic maneuvering by the newly minted Prohibition Bureau seeking enhanced status and some very close poorly thought out Supreme Court decisions circa 1920. If someone is addicted to a certain drug it is not a societal problem, it is an individual problem whose best solution may very well be maintenance. It is prohibition that turns it into a societal problem.

Anthony Gregory - 5/4/2006

See, this is how it works, Lisa. When the government takes half the wealth of the poor and middle class, year after year, it is compassionate. When someone on the market offers to sell something to those who want it for too high a price, it is considered evil.

On the other hand, Hurwitz would have no way of charging so much for prescriptions if we got rid of licensing, prescriptions, the FDA, medical corporatism and the war on drugs. His captive market is a result of government intervention in the health care sector, not laissez faire.

Lisa Casanova - 5/4/2006

What price level automatically makes you compassionate?

Lisa Casanova - 5/4/2006

"accept the fact that everyone has to deal with pain and tough times"?? Maybe I've completely misinterpreted this statement, but are you saying that you somehow know how much pain other people deserve to be in? It certainly sounds like you views on drugs are really just an extension of your personal predjudice that other people take too many pills.

John Richard Clark - 5/3/2006

A physician who charges a $1,000 fee for initial consultation and requires $250 per month to renew controlled substance prescriptions is hardly a "compassionate doctor."

John Richard Clark - 5/2/2006

Last year, the DEA arrested 42 physicians out of a total of 1 million practicing MDs. Not much of a war, if you ask me.

Interesting that Anthony mentioned Dr. William Hurwitz. If you are the kind of physician (as Hurwitz was) who prescribes 1,600 pain pills _per day_ for a patient, you can count on coming to the attention of the DEA. Nobody---nobody has the respiratory or central nervous system to tolerate 1,600 narcotic pain pills in one month, let alone one day. It doesn't take a rocket surgeon to conclude that Hurwitz was prescribing to people who were in turn selling the Rx drugs to others.

It certainly didn't help his case in the courtroom when the DEA presented photos taken in Hurwitz's waiting room of patients with needle-tracks and bruises on their arms.

Keith Halderman - 5/2/2006

The third party payer system absolutely benefits allopathic physicians because that is the only kind of treatment that gets paid for. This is also a very strong argument against the euphemism universal health care, which is in reality government rationed health care. The history of medicine is the story of how allopaths achieved their monopoly position through use of government coercion. As for the conflict of interest it does exist, now maybe your wife puts the patient’s interest ahead of her own financial interest, although since she is on salary (by the way doctors who accepted a salary from say the Moose Lodge were considered professional pariahs in the past) it does not matter if someone keeps coming back, other fee for service doctors may not be so scrupulous. Our fundamental disagreement is this; I believe people are responsible for their own behavior and that includes actions pertaining to their health while you believe, at least in this matter, that people are not responsible and therefore need a benevolent parent, government, to look after them. The problem is that government acts much more like a child abuser, always choosing the course that benefits itself, than a good parent.

John Richard Clark - 5/2/2006

Keith, you say that "too much of the institution is designed for the benefit of the physician and not the patient and this includes the prescription laws."

That sounds similar to the criticisms of health care expounded by nationalized medicine advocates.

The system is in fact designed for the benefit of the THIRD PARTY PAYER, not the physician. Private insurance companies control health care. You can be the best-skilled and the most compassionate doctor on earth, but if you are not in network for your patient population, you will starve. Medicaid and Medicare also dictate to physicians the type of services doctors can provide, and soon that control will extend to prescription drugs.

As far as the prescription laws are concerned, I must also disagree. I've posted this before, and I'll post it again: unless you have extensive training in pharmacology and pharmacokinetics, you are woefully ignorant about the mechanism of action of drugs, the distribution of the drug throughout the body, the excretion fraction of the drug, how it acts on liver enzymes, etc. Believing you know enough to administer prescription drugs is as silly as asserting you can fly an airplane without "state-sanctioned" training.

You also say "there is an inherent conflict of interest between how healthy a person is and how much money a doctor makes."

Something tells me you don't know much about the medical profession. Let me use my wife as an example. While her fellow college graduates entered the workplace and began earning money, she spent four years in medical school (and racked up about $150,000 in student loans) and two years' of residency (where she was paid $35,000 a year).

Now she is an employee of a corporate family practice near Charlotte. She makes somewhere between $120,000-$130,000 a year seeing 20 to 25 patients a day, five days a week, fifty weeks a year. For one week out of every three, she is on call, 24 hours a day, and frequently has to go to the hospital for 2-3 hours in the middle of the night to see about a patient who had to be admitted. After half her income is withheld for taxes, her student loans are paid, and her malpractice insurance is covered, she makes about as much as a corporate middle-manager. It is not as glamorous as the soap operas and TV shows would have you believe.

I don't understand the "conflict of interest" business. As a family medicine practitioner, my wife constantly preaches healthy lifestyle choices, particularly since the vast majority of her patients suffer from lifestyle-induced disease states, like obesity, hypertension, heart disease, and pulmonary disease.

And this all gets to the point I have been trying to make. Patients don't want to hear from doctors that they need to suck it up, live a healthy lifestyle, and accept the fact that everyone has to deal with pain and tough times. What patients want is a pill that will make them thinner without any physical effort, a drug that will numb them from everyday life, or an antidepressant or sedative that will allow them to escape their responsibilities.

John Richard Clark - 5/2/2006

I am not in favor of prohibiting drugs. I do support the current system of OTC/Rx/controlled drugs, with Rx and controlled drugs administered under the supervision of a medical professional.

Lisa Casanova - 5/2/2006

Mr. Clark,
You specifically mentioned the damage caused by drug addiction. Whether alcohol has any benefits, addiction to it certainly is destructive. So why your support of drug, but not alcohol, prohibition?

John Richard Clark - 5/1/2006

Environmental protection, sanitation, clean air and surface water, uncontaminated food and drinking water, and control of infectious disease are all part of public health and represent a collective good. They can be secured ONLY through organized action on behalf of the population.

Your diatribe against the FDA is the typical libertarian cliche: The FDA is solely responsible for any death or sickness where it might have prevented treatment by the latest unproven fad.

Regarding addiction: why do you compare alcohol, a substance which has no therapeutic use in medicine, with narcotic prescription drugs, which do have therapeutic value? Clearly a case of apples and oranges.

Lisa Casanova - 5/1/2006

Mr. Clark,
I did not say I am perfectly capable of deciding the appropriate drug therapy for the “vast majority" of illnesses. I am, however, perfectly capable of deciding whether a drug is an appropriate choice for me for, say, the disease I've lived with for the past 21 years. There’s no one else capable of making that choice, no matter how many years of medical training they’ve had. The FDA is based on the premise that strangers know better than I do whether the risk-benefit tradeoff of a particular drug for my disease is acceptable for me. That's arrogant. I’m not asking to make that choice for anyone else- only myself. I see nothing arrogant about that.
As for your points about pain, I never said doctors cannot pinpoint sources of pain. That's part of medical diagnosis. But there's no test for how much pain someone is in. Doctors do have to go on what their patients say to know that. I certainly hope you're not suggesting that if there's not something to be seen on an x-ray, it's ok to assume patients are lying about pain and withhold relief. I am also aware of nondrug methods to treat pain. While they have their place, they are not effective or appropriate for everyone.
As for your point about public health, I am perfectly familiar with antibiotic resistance (it was the subject of my master's thesis), and I dispute your contention that public health is a collective good best administered by government. We have a prescription system now for antibiotics, and it has failed to halt the development of resistance. Resistance is a constantly evolving phenomenon, and it frustrates our best efforts to stop it. Government regulation certainly has been no panacea. There’s no magic formula that regulators know that tells them whom to give antibiotics to and whom to withhold them from to maximize benefit, but that is what you are suggesting we rely on them to do. All it accomplishes it depriving people who need medicines now of treatment in favor of future people who might possibly be harmed. Do you have the right to demand that other people not receive an antibiotic you think you might need someday, in order to preserve its effectiveness? That’s where that reasoning leads. Calling public health a “collective good” makes it into a zero-sum game in which some people only benefit at the expense of others.
One final note: yes, addiction wreaks havoc in people’s lives. If you’re truly concerned about the terrible consequences of addiction, I await your posts advocating complete alcohol prohibition.

Anthony Gregory - 5/1/2006

In a free society without a nightmarish war on drugs, the children of drug addicts would have a tough time, just as they do now. But the drug war just adds another layer of tragedy to the situation.

Libertarianism doesn't promise to solve all problems. But libertarians oppose initiating force upon the innocent as a means of solving problems. Government, on the other hand, does tend to promise to solve all of the world's problems, and it never succeeds.

I have a question for you. What about the hundreds of thousands, of non-violent people who are currently locked away for drug charges? What about the many being raped and beaten right now? How does the drug war offer them justice? Oh wait, I forgot. It was the drug war that put them there.

John Richard Clark - 5/1/2006

I could equally argue that arrogant libertarian reasoning regarding drug use. abuse, and addiction leads to all manners of inhumanity like, say, the neglect and abuse of drug addicts' children or fetuses damaged by their mothers' drug exposure. How, under a libertarian scheme, would those victims obtain justice?

Keith Halderman - 5/1/2006

Last night I watched the movie Hospital and I believe the underlying point of this film is that people should be much more skeptical of modern medicine. Too much of the institution is designed for the benefit of the physician and not the patient and this includes the prescription laws. I am sure your wife is a lovely person who does her best to help people but the fact remains that there is an inherent conflict of interest between how healthy a person is and how much money a doctor makes. We have given doctors way too much power over peoples lives. Thomas Szasz calls it the therapeutic state. Besides in this discussion we are not talking about doctor's power but rather the power of DEA bureaucrats to make medical decisions. People who have a self interest in demonizing drug use.

Keith Halderman - 5/1/2006

The two items you link to are not ads for patent medicines. They are ads for heroin and cocaine. Both drugs were widely accepted and praised when first introduced. Fear inducing propaganda against them built slowly so that by 1906 patent medicine manufactures did not want them to appear as ingrediants on their labels.

Anthony Gregory - 5/1/2006

Do I understand what you're implying? That since at least some manufacturers "prominently featured HEROIN and COCAINE in their advertising," we can conclude that Keith Halderman is wrong that patent medicine manufacturers "fought putting opium etc. on the labels of their products because they knew it would hurt their sales"? If so, would it not stand to reason that the cries for mandatory labeling and the Pure Food and Drug Act weren't necessary, after all? As you appear to imply, manufacturers were forthcoming, even boldly explicit, about the contents of their drugs.

John Richard Clark - 5/1/2006

"They [patent medicine manufacturers] fought putting opium etc. on the labels of their products because they knew it would hurt their sales. They knew that Americans would largely reject those drug [sic] without any need for government coercion."

Then how do you explain these ads dating from before the Pure Food and Drug Act? Seems like the manufacturers prominently featured HEROIN and COCAINE in their advertising.

Anthony Gregory - 5/1/2006

John Richard Clark writes to Lisa Casanova:

"It's arrogant to say you are 'perfectly capable' of deciding for yourself the appropriate drug therapy for the vast majority of illnesses. It takes almost a decade for MDs to learn the specialized knowledge you claim to have. Let's take a simple example like a headache. . . ."

It's arrogant to say that just because an individual might not have the medical knowledge that the state-approved experts do that the state has a moral right to use the threat of violence and imprisonment to prevent people from making their own choices about their own bodies, whether informed or not. Not only is it arrogant, such reasoning opens the doors to all manners of inhumanity.

John Richard Clark - 5/1/2006

Ms. Casanova,

My wife is a family practice MD in North Carolina and I have consulted her in the rebuttal to your comments.

1. Doctors do not just "go on what patients report" to diagnose sources of pain. They use physical examination, radiology, MRIs, CT scans, and even, in some cases, blood tests.

2. You are overgeneralizing when you state that "addiction is almost always on doctors' minds" in considering pain control. Acute pain patients and chronic malignant pain patients present very little addiction potential for physicians. In the former case, narcotic pain medication is only administered for a set period; in the latter case, doctors err on the side of overprescribing in the interest of making a patient comfortable in their last days. However, patients with chronic, nonmalignant pain present the greatest potential for addiction.

It's unusual that you complain loudest about the role of narcotics in the treatment of pain and totally neglect the other treatment modalities for pain control. Numerous studies show that medication ALONE is ineffective in the treatment of chronic pain---patient education, physical rehabilitation, and psychosocial counseling all must play a part in the treatment of chronic pain.

3) You state, "If a few drug seeking patients get painkillers, is that such a terrible outcome that it justifies witholding drugs from people in pain?"

There are two things wrong with this statement: First, it implies that doctors view all pain patients the same way. Physicians treat patients as individuals and make diagnostic and therapeutic decisions based on the individual patient's symptoms.

Second, physicians have a duty NOT to do harm to their patients. A doctor who enables a patient with a drug addiction is making them sick. Narcotic addiction is a physical and mental illness.

4. The DEA doesn't do as much "watching" as the article would have you believe. The real "watchdog" of prescription drug abuse is the retail pharmacist. Pharmacists report unusual prescribing activity to their regulatory body, the state drug control agency (whose agents are licensed pharmacists as well as law enforcement officers). The DEA only gets involved if the state drug control agents find substantial evidence of irresponsible prescribing. In that case, the DEA is necessary because it issues the physician's license to prescribe narcotics.

5. Physicians do NOT perceive narcotic painkillers as "horrible" or "dangerous" when prescribed under the care of a doctor.

6. Government DOES keep drugs sequestered for valid public health reasons. Public health is inherently a collective, not an individual, good. Are you familiar with the term antibiotic resistance? Even with the responsible use of antibiotics, there are infectious diseases that have adapted to pharmacotherapy and some are resistant to all but a select few agents that represent the last line of defense. If individuals had the license to take whatever drug they thought best to treat infection, the world could see pandemics along the lines of influenza and bubonic plague. It would be impossible to trace the original host for the infection and hold him or her responsible for the loss of life.

7. It's arrogant to say you are "perfectly capable" of deciding for yourself the appropriate drug therapy for the vast majority of illnesses. It takes almost a decade for MDs to learn the specialized knowledge you claim to have. Let's take a simple example like a headache. Could you differentially diagnose among the following possibilities (migraine, tension, cluster, benign intracranial hypertension, high-pressure hydrocephalus, septic or aseptic intracranial thrombophlebitis, extracranial venous occlusion, cerebrospinal fluid leakage, post-lumbar puncture headache, meningitis, encephalitis, subdural abscess, empyema, subarachnoid hemorrhage, intracranial hematoma, brain tumor, pituitary tumor, paranasal sinusitis and tumors, dental infections, otitis, ocular lesions, cervical osteoarthritis, or cranial arteritis)? Not all of the above conditions can be treated by narcotic pain medications. In some cases, narcotics can make the condition worse.

8. Decision-makers in public health have to weigh collective benefits and risks---as stated above, public health is a collective good.

Keith Halderman - 4/29/2006

The Pure Food and Drug Act of 1906 did not ban any drugs it merely required patent medicines to list the ingredients on their labels. Many of these medicines contained opiates, cocaine and cannabis hemp. The patent medicine makers resisted the idea of labeling very strenuously. This historical fact completely undercuts the rationale for drug prohibition. The argument in favor of prohibition says that unrestricted access led to a drug seeking American population before the anti-drug laws such as the Harrison Act were in place. However, if this were true then why would the patent medicine manufacturers resist putting opium etc. on their labels? Would that not be a selling point to a drug crazed populous? No, they fought putting opium etc. on the labels of their products because they knew it would hurt their sales. They knew that Americans would largely reject those drug without any need for government coercion.

Anthony Gregory - 4/28/2006

1) I think you mean, 1906

2) The Import Drugs Act was unnecessary and ineffective. For years, the professional and academic community was rapidly improving its means of regulating drugs on the market, publishing journal studies, publicizing the names of contaminated drug distributors, providing people with ways to detect adulterated drugs. This is the best way to deal with it in a free society. If someone passes something off dishonestly that hurts someone—which will sometimes happen no matter how many preemptive safeguards the state erects—he should be dealt with for committing fraud. But you don't need a federal regulatory apparatus to do that, much less a full-blown war on selected drugs. Much of the legal reform people were most loudly demanding, in fact, was legal action against mislabeling—a fraudulant act that can be handled without unbridled leviathan or smashing the right to self-medicate and put what you want in your body.

Many pharmacists were behind the Drug Importation Act because they thought it would make their job easier. And indeed, there was a lot of political pressure for regulation because of the sweeping problems with medicating so many of the injured and ill from the invasion of Mexico. It's kind of hard to blame all those deaths on the market, though, and to ignore the crucial role of the state in such a spike in the mortality rate among the able-bodied and healthy. Many of the deaths were a result of incompetent doctors that the government had hired to nurse its imperial cannon fodder back to health. Poor and anachronistic treatments, such as bleeding patients to eliminate their bad blood, were rampant. At the time, the government was hardly a paragon of medical wisdom.

Enforcement of the 1848 Act presented myriad problems. At the beginning, when it was supposedly most necessary, during the war, the implementation wasn't very well funded. Soon after its passage, domestic adulteration increased. There was also massive corruption on the part of Customs officials, and a proposal in the 1860s to punish officials who assisted in fraudulant importation with dismissal from their posts, a prohibition on their working in Customs again, and jail time, failed. Can't expect the regulators to regulate themselves.

These days, with the internet and other technologies, the pretense for government regulation of drugs is even thinner.

People have a right to put in their bodies what they want, and there are plenty of resources to help people inform their decisions. None of them are perfect, of course, but the government's propaganda, backed up by its violence, is not the best doctor in town.

3) I'm trying not to sound crude, but hundreds of overdoses is not exactly an epidemic when compared to society at large. Hundreds of American OD on caffeine and aspirin every year, and thousands die from highly regulated, state-licensed pharmacists handing out the wrong drugs. "A 1996 study, published in the journal Human Factors, found that 3.2 percent of prescriptions were filled in error. Researchers spent 23 days double-checking 5,072 prescriptions and found 164 mistakes, including labels with wrong instructions and wrong drugs in bottles."

4) Yes, Thalidomide is the one example that the pro-FDA people always bring up. It was horrible for thousands of people. But what about all the tens, even hundreds of thousands, who have died because the FDA kept drugs out of their reach? Such as the tens of thousands Americans who died in the 1960s because they couldn't get Propranolol, the first effective beta-blocker to be approved for hypertension, which was freely available in much of Europe but kept of the market in America for years? Their case alone was as tragic as the Thalidomide calamity.

What about the many, many thousands whose illnesses are too rare for drug companies even to invest the necessary resources to find cures for, since the FDA imposes hundreds of millions of dollars in bureaucratic costs for a company to bring a drug to market—after the company tests its own drugs, of course.

Ultimately, if you're dying, especially, you should have the right to put anything in your body that might save your life, even if it might have nasty side effects. The FDA shouldn't be allowed to violently stop you. It's just not right. Good drug testing, which is done by the companys' labs anyway, is important. No one wants to kill their customer, but sometimes it happens. But the answer isn't the horribly coercive apparatus of the FDA, which is in reality a protection racket to keep the biggest pharma companies entrenched and the smaller ones out of the market.

Incidentally, Thalidomide has only recently been approved for treating symptoms of leprosy and other diseases, and is awaiting approval for prostrate cancer, lymphoma and other maladies. Unfortunately, the very negative effect it was shown to have on embryos has delayed its approval for other illnesses more than we'd expect in regard to a drug with less sensationalized baggage.

Many drugs have horrible side effects. Alcohol and tobacco and various foods and aspirin kill thousands a year. Prescription drugs, approved by the FDA, handed out by licensed pharmacists, kill thousands. But the FDA's cold shoulder to those in need of new, lifesaving drugs, who are willing to take a risk and have nothing to lose, is downright inhumane. And if people don't have a right to control their own bodies, surely they have no right to control the bodies of others, and yet that is what you think the FDA should be allowed to do.

5) Libertarians don't "place an impossible threshold on government and expect it to function perfectly." They simply point out that when you unleash a monopoly on violence to solve society's alleged problems, allowing it to violate the ethical guidelines of conduct that all of us must observe in our day-to-day relations with one another if civilization is to function, it usually makes things much worse. State cntral planning is a pracitcal and moral disaster.

An example of how drug policy is a mess? How about hundreds of thousands of peaceful people behind bars? That alone is worse than any drug use problem that America has ever had. Add in the destruction of due process and civil liberty, the economic costs, the tens of thousands dying because of FDA lags, the aggressive military actions to combat drugs, and the gang warfare, and calling America's drug policy a "mess" becomes a clear understatement.

John Richard Clark - 4/28/2006

1) Please excuse the typo on the above was 1903.

2) The US government actually began the process of regulating the corrupt pharmaceutical marketplace as early as 1848 during the Mexican War, with passage of the Import Drugs Act. In an unregulated marketplace, unscrupulous domestic and international drug manufacturers dumped contaminated and counterfeit medications on the US public. In particular, US Army troops suffered during the war from the effects of contaminated malaria medication.

3) The Pure Food and Drug Act DID have an effect on American patients. One hundred years ago, the pharmaceutical industry in the US was a nightmare. Medicines containing morphine, opium, heroin, and codeine were sold without restriction and labels did not list ingredients. The muckrakers of the early 1900s discovered hundreds of cases of overdoses due to improper formulation of patent medicines.

4) One word that justifies the existence of the Food and Drug Administration: Thalidomide. Europe and Canada failed to regulate and innocent parents and children paid the price for it.

5) Libertarians place an impossible threshold on government and expect it to function perfectly. You call the current system a "mess." How about some examples?

Lisa Casanova - 4/28/2006

Mr. Clark,
I couldn't disagree with you more. First of all, how do you verify how much pain someone is in? There's no blood test for pain levels. Doctors go on what patients report, and I know from personal experience that in discussions about pain control, addiction is almost always on doctors' minds. If a few drug seeking patients get painkillers, is that such a terrible outcome that it justifies witholding drugs from people in pain? With the DEA always watching, it's better for doctors to err on the side of not treating pain. All the DEA's crackdown does is make doctors wonder if every patient is drug seeking. And although it's anecdotal, so take it for what it's worth, I have heard a physician express the opinion that many patients who report pain are "just drug seeking anyway". How many of those are people in real pain being undertreated by this doctor? Our distorted perception of painkillers as horrible and dangerous hurts our ability to treat pain.
Also, the government does not "keep dangerous drugs sequestered for legitimate public health reasons". If you're an uninformed user of a drug, you have no business being a user of it, period. People are not children. There is no reason to sequester any drug from us, when we're perfectly capable of deciding for ourselves whether the risk-benefit tradeoff is acceptable. If you think this is libertarian folly, I suggest you withold judgement until you've sat through an FDA meeting waiting for a group of strangers to decide if you get any access at all to a drug that can help you, based on whether people who have never met you and know nothing about you ( and have never lived with your disease) decide that your life sucks enough to justify giving you a drug THEY think it dangerous, because people who won't educate themselves about the risks might hurt themselves taking it. It's a seriously screwed up system, and I urge you to give the issue a lot more thought before you dismiss it as folly.

Anthony Gregory - 4/28/2006

BTW, the impetus for regulating drug manufacturers (and food distributors) during the Progressive Era was largely to protect and entrench Big Business. It was the corporate state at work, rather than a much-needed reform to protect the common man. When drugs were regulated by the marketplace, there were no more problems with overdose, etc., than now, when the government has made a mess of the whole area.

As for doctors not fearing the DEA, I'm not sure about that. Look at Dr. William Hurwitz.

Anthony Gregory - 4/28/2006

"Libby also gets the history wrong. Before the Harrison Act, Congress passed the Pure Food and Drug Act of 1903, in part because patent medicine manufacturers in an unregulated marketplace refused to ensure consistent dosage strength and purity of the manufacturing process."

Actually, speaking of getting history wrong, the Pure Food and Drug Act was in 1906, and had little impact on ordinary patients and doctors. The Harrison Act was indeed the first major federal domestic drug regulation, banning heroin and heavily controlling cocaine and morphine.

John Richard Clark - 4/28/2006

Not even a pretense of objectivity. Sloppy scholarship, which explains why the article ended up in a libertarian journal predisposed to drug legalization.

Libby argues that Americans with acute and chronic pain are undertreated by doctors.

A cursory search of the top 200 prescribed drugs for 2004 reveals a narcotic opiate painkiller at the number 1 position.

Doctors wrote 92 MILLION Lortab prescriptions in 2004.

Libby seems obsessed with Oxycontin. It is the medication of last resort for outpatient end-stage terminal patients, not an everyday drug used to treat headache. Oxycontin is a dangerous drug that can kill an uninformed user. I realize that the Social Darwinians among you love that sort of thing, but our medical system sequesters dangerous drugs for legitimate public health concerns.

Libby also gets the history wrong. Before the Harrison Act, Congress passed the Pure Food and Drug Act of 1903, in part because patent medicine manufacturers in an unregulated marketplace refused to ensure consistent dosage strength and purity of the manufacturing process. I realize that some of you libertarians believe in caveat emptor, but patients who died from accidental overdose had little recourse to the civil justice system.

Doctors don't fear the DEA; what they fear are drug-seeking patients who present with phantom symptoms that are unverifiable by observation or diagnosis.

If a patient visits a doctor believing they have diabetes, yet blood and endocrine tests indicate that insulin levels are normal, the doctor would commit malpractice if they prescribed anti-diabetic drugs to the patient.

This is yet another example of libertarian folly.

Sudha Shenoy - 4/26/2006

How many bureaucratic careers are built on this? What rewards did the officials get for successful prosecutions? How many cases/investigations must they conduct to pass their efficiency test, as good officials? ETC.