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Calvinists in the Medicine Cabinet


I’ve always been what’s now called a social libertarian — it’s a fine English tradition dating from the days of Bentham and John Stewart Mill, and if you can fuzz it a bit, you can trace it back to the English supporters of Henry II — the Knights of the Grand Assizes. (Henry II was a Norse Froggy, don’t forget). And the philosophy remains: You should be able to do whatever you like so long as it doesn’t hurt someone else. But sadly, another European tradition coming out of the same Reformation period has been predominant in the U.S. The notion of intolerance of other people’s behavior has played a strong part in the U.S. due to its Calvinistic heritage. That intolerance comes out in much of the current conservative domination of our politics, but none so much as in what I call the “war on (some) drugs”. Sadly that war – or should we say massacre, as there’s no army to protect those who disagree with the intolerance of the government – has moved front and center into medical care.

This comes out in several areas, in which patients and their representatives have been fighting a rearguard action to be allowed to deal with their medical conditions in the way that they want. The most obvious is the medical marijuana (MM) movement, which has developed into a twilight world in several American cities, where the states and local jurisdictions support the rights of patients to use MM, but the Federal government using some incredible twisted manipulation by the Supreme Court — the same ones who brought you the Bush Administration — has effectively outlawed it.

But marijuana was never in the medical mainstream, and never likely will be. Opiates are a different matter. It may surprise you to know that the biggest opium crop in the world comes not from Afghanistan, but from the Australian state of Tasmania. And there have actually been serious calls to allow the Afghans to grow opium for the same purpose — to be used as the basis for medical grade morphine.

Why do opiates matter? Because they are essential medication for one of the most under-treated medical conditions: chronic pain. How bad is this under-treatment? A report out this week shows that:

According to the American Geriatrics Society Panel on Persistent Pain in Older Persons, 45 to 80 percent of nursing home residents have substantial pain.  The consequences of poor pain management include sleep deprivation, poor nutrition, depression, anxiety, agitation, decreased activity, delayed healing and lower overall quality of life. Fewer than half of nursing homes residents with predictably recurrent pain were prescribed scheduled pain medications

So for this incredibly vulnerable class — yup, that’s grandma — pain is a daily occurrence, and it’s not treated properly in more than half of those cases.  That of course goes for the rest of the medical system, where patients in pain have to run incredible ordeals to get medicine that government guidelines acknowledge that they need.

The government’s jihadists in the U.S. Drug Enforcement Agency, supported by their fellow theocratic fascists in local district attorney’s offices across the country, have been waging assaults on physicians who prescribe these medications. Cato’s Randy Balko reports on just the latest case where an aggressive DA tells a jury that a doctor is “selling scripts” for $75 (i.e. charging for an office visit), and the doctor goes down for 20 years. No matter that in case after case (read the comments here) it’s clear that the doctor has simply being practicing medicine the best they could and trying to help patients — who now are forced to get the medications any other way they can.  And of course now, with the Richard Paey case, prosecutors are coming after patients.

This culminates in the most critical decision of all —  one that is only fit for the individual and their family and physician to make. How to deal with terminal illness at the end of life. The Calvinistic heritage of this nation is such that this was so little talked about that the majority of the debate was led in the 1990s by a man crazy enough to go to jail for life for his beliefs. And in jail Jack Kevorkian sits. But of course physicians have forever been helping people on their way who want to end their suffering, usually in extreme circumstances. And of course plenty of ordinary people have been doing that with only minimal help too. Read these three short chapters from comedian Chris Bliss about his brother’s assisted suicide.

Here in the U.S., the DEA under former Attorney General John Ashcroft, actually went after the licenses of Oregon doctors prescribing “controlled substances” — overdoses of opiates — to people who had, legally under Oregon law, requested help in dying without suffering. Luckily in one of the last rulings that Supreme Court Justice Sandra Day O’Connor made, the court voted 6–3 that such a back door tactic to overturn the law was illegal, but with fewer of her and more Justice Scalito’s on the court, it’s not hard to see that this one won’t last forever.

Towards the end of this debate, the medical profession has slowly started to wake up, even as the American Medical Association and other physician groups have let pain management specialists and other doctors wrongly accused of crime hang out to dry with almost no comment. In a recent New England Journal of Medicine article, two leading physicians (one in favor of assisted suicide, one against it) criticized the DOJ assault on the Oregon law, realizing that it was in fact an assault on the freedom of physicians to do what’s best for their patients, and not just at the end of their life.

Of course the Calvinists in the DEA and elsewhere don’t care about the doctor-patient relationship. They don’t care about people being in pain. They just care about their moralistic intolerance. But they are ably backed up by the economic fascists in the DEA and other law enforcement agencies who are happy to apply the appalling laws of forfeiture to the easy targets that pain management doctors make. Which of course means that fewer and fewer of them will help you when you are in pain.

And remember the stats. By the time you’re in your eighties, 80% of you will need help for pain. You’d better hope the Calvinists are beaten back, or it could be a grim future.

Share  Posted by Matt Holt at 10:18 PM | Permalink

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