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FULL HEARING: Facebook Whistleblower Testifies Before Senate Judiciary Committee
Beyond Medical Paternalism: Restoring Control to the Individual
Beyond Medical Paternalism: Restoring Control to the Individual
Heavy-handed government policies often undermine patient autonomy, restricting the medicines they can take, the doctors they can see, and the information they can access.
rom the earliest days of their training, health professionals are taught the critical ethical principle of respecting their patients’ autonomy. But in the broader realm of public policy, that principle often gets trampled under the weight of bureaucracy.
Government agencies frequently dictate which doctors a patient can see, restrict access to new medications, and even regulate the information pharmaceutical companies can share with consumers.
Autonomy in health care is not just an academic ideal. It’s about empowering individuals to make decisions about their lives, their bodies, and their well-being. But while doctors are bound by the principle of informed consent, government policies often assume that individuals are incapable of making informed choices about their own health.
A Shift in Medical Ethics: From Paternalism to Informed Consent
The doctrine of informed consent—the right to accept or refuse medical treatment even at personal risk—is a relatively modern concept. Barely a century ago, it was commonly accepted that doctors could do whatever they thought was in the best interests of their patients, regardless of a patient’s wishes or priorities.

Dr. Jeffrey Singer, who has worked in private practice as a general surgeon for over 35 years, at his medical office in Phoenix. (Photo by Duane Furlong Studios)
This model of care sometimes had tragic results. From 1932 to 1972, the Tuskegee Syphilis Study saw government health agencies withhold treatment from nearly 400 black men to observe the progression of the disease while intentionally not informing participants that a cure for the disease existed. Even as late as the 1970s, some doctors routinely withheld diagnoses from cancer patients, fearing the emotional impact would derail treatment.
“Today, informed consent is a cornerstone of the patient-doctor relationship. But outside the exam room, government policies often ignore this principle, restricting individual autonomy in profound ways.”
Today, informed consent is a cornerstone of the patient-doctor relationship. But outside the exam room, government policies often ignore this principle, restricting individual autonomy in profound ways.
Barriers to Choice: Licensing Laws and Monopolies
State licensing laws, originally framed as a means of protecting public health, now often serve as barriers to patient choice. In the 19th century, the American Medical Association lobbied aggressively for laws that restricted entry into the medical profession. Over time, similar restrictions spread to other health professions, creating a complex web of regulations that limits competition and stifles innovation.
This dynamic is evident in the turf battles that play out in state legislatures, where professional groups vie to protect their monopoly over specific practices. Patients are left with fewer options, and the assumption persists that the government knows better than individuals who should provide their care.
But as economist Milton Friedman noted, licensing laws rarely ensure quality care. Instead, they raise costs and limit access. Private accrediting organizations could fill this role, providing certifications that help patients make informed choices while opening the door to greater competition and innovation.
“Without [medical licensing], they would have no power to do harm,” Friedman told a group of medical professionals at the Mayo Clinic in 1978. “Why is that the case? Because the key to the control of medicine starts with who is admitted to practice.”
The Freedom to Access Information
Health and Human Services Secretary Robert F. Kennedy Jr., who was nominated by President Trump with a mandate to “Make America Healthy Again,” has argued passionately against the “priesthood” of the medical establishment, calling for greater transparency and personal responsibility in health care. Yet he supports banning direct-to-consumer advertising by pharmaceutical companies—a move that would restrict patients’ ability to access vital information about treatment options.
The US Supreme Court has repeatedly affirmed that the First Amendment protects the free exchange of scientific information. Prohibiting pharmaceutical ads would make clinicians the sole gatekeepers of knowledge, further disempowering patients. Policymakers should reject such bans and embrace policies that enhance transparency and trust.
Ending the Prescription Monopoly
Since 1938, the federal government has controlled which medications Americans can legally purchase. In 1951, Congress expanded that authority, requiring prescriptions for certain drugs—a decision previously made by pharmaceutical companies. While intended to protect public health, this policy has driven up costs, delayed access to life-saving treatments, and forced patients to navigate unnecessary bureaucratic hurdles.
Patients in other countries often access medications over the counter that require a prescription in the United States. Reforming this system—whether through small changes or sweeping overhauls—could help restore patient autonomy and reduce health care costs without compromising safety.
The Right to Choose Substances
Prohibition didn’t work for alcohol, and it hasn’t worked for drugs. Yet for over a century, government policies have criminalized substances for medical and recreational use, creating black markets and fueling violence.
In many cases, driving these drugs underground makes them far more dangerous and deadly. For example, opioids, when used responsibly, are less harmful to organ systems than alcohol or tobacco. But prohibition has pushed these drugs into the black market, where adulteration and unknown potency make them far more dangerous.
More recently, lawmakers have set their sights on food additives. Proposals like the Do or Dye Act and the Stop Spoonfuls of Fake Sugar Act aim to ban certain dyes and sweeteners. Instead of letting consumers make their own choices, these measures would increase costs and limit freedom—all while ignoring policies that drive the use of cheaper additives, such as agricultural subsidies and import tariffs on sugar that incentivize the use of high-fructose corn syrup.
Embracing Harm Reduction
Harm reduction is a pragmatic approach to health care that seeks to minimize the risks associated with certain behaviors without endorsing them. It’s why doctors prescribe medications for smoking cessation or manage chronic conditions linked to lifestyle choices.
But federal and state laws often block harm-reduction strategies for drug users. In five states, distributing fentanyl test strips—tools that can detect lethal contaminants—is illegal. A federal law known as the “crack house statute” prohibits overdose prevention centers, where drug users are monitored and opioid antidotes and oxygen administered. Such centers have saved lives in 16 countries since 1986.
These policies not only infringe on personal autonomy but also exacerbate the problems they claim to address. By embracing harm reduction, policymakers could save lives and empower individuals to make safer choices.
Toward a Healthier, Freer Future
In my forthcoming book, Your Body, Your Health Care (Cato Institute, April 2025), I explore the many ways government paternalism has eroded personal autonomy, often with devastating consequences. Restoring this autonomy isn’t just a matter of principle—it’s a path to better health outcomes and a freer society.
If the Trump administration is serious about “making America healthy again,” its first priority should be to return control to the individual.
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DOJ Considers Opioid Use Disorder an ADA Covered Disability and Pursues Claims Against a Provider for Refusing Medical Services to Opioid Users
According to this article, Selma Medical had a policy to not prescribe narcotic controlled substances to any pts. This was SIX YEARS ago, why has there not been a lot of lawsuits against practitioners that refuse/decline to treat pts whose health issues require the use of opioids?
DOJ Considers Opioid Use Disorder an ADA Covered Disability and Pursues Claims Against a Provider for Refusing Medical Services to Opioid Users
The U.S. Department of Justice reached a January 31, 2019 settlement of an American with Disabilities Act (“ADA”) Title III complaint against health care provider Selma Medical Associates relating to provision of medical services to an individual with opioid use disorder (“OUD”). The settlement is notable for health care providers and employers as it makes clear that DOJ considers OUD as a disability under the ADA thereby triggering the full panoply of ADA rights for those with OUD.
The DOJ complaint was premised on the alleged refusal of Selma Medical to schedule a new patient family practice appointment after the patient disclosed he takes Suboxone. Suboxone is a prescription medication approved by the Food and Drug Administration for treating OUD. The complaint further alleged that Selma refused to treat patients with narcotic controlled substances, including Suboxone, thus imposing “eligibility criteria that screen out or tend to screen out individuals with OUD.” The compliant also alleged a failure to make reasonable accommodations to policies, practices or procedures when necessary “to afford such goods, services, facilities, privileges, advantages, or accommodations to individuals with disabilities.”
Under the settlement, Selma agreed to:
- Not discriminate or deny services on the basis of disability, including OUD;
- Not use eligibility standards, criteria or methods of administration that tend to deny benefits on the basis of disability including OUD;
- To modify its policies as necessary;
- To draft and submit within 30 days for DOJ approval a non-discrimination policy and to remove any inappropriate existing policies;
- After DOJ approval, to adopt and disseminate to all employees the new non-discrimination policy;
- To train all management and employees within 60 days and annually for three years as to the new policy and ADA compliance with the initial training conducted live, with a Q&A opportunity, and by a trainer to be approved by DOJ;
- Submit compliance reports to DOJ for three years; and
- To pay compliant $30,000 in damages and a civil penalty to the U.S. of $10,000.
The DOJ-Selma Medical settlement is highly significant in an environment where in 2015, OUD affected 2 million people aged 12 and over (Drug and Alcohol Dependence, Vol. 169, Dec. 2016, pp. 117-127) and .6 million persons aged 12 or over had heroin use disorder (id.) and the lifetime percentage of individuals with Diagnostic and Statistical Manual-IV prescription OUD among adults 18 and over had more than doubled from 1.4% in 2001-2002 to 2.9% in 2012-2013 (id.), and likely higher today. And, of course, this does not include those who are OUD for reasons other than prescriptions. This means that health care providers are highly likely to encounter significant numbers of potentially challenging OUD patients. DOJ has now made clear that providing the full range of care and services to such patients is required under the ADA – and that any failure to do so can lead to litigation, costly settlements and adverse publicity.
All employers, not just health care providers, should take note of this settlement as it clearly means that employers will also need to reasonably accommodate employees who seek time off for treatment or other accommodations unless the employer cannot show the requested accommodations would be an undue hardship.
The Selma Medical settlement is also a reminder that health care providers should make sure they have appropriate non-discrimination policies in place as required pursuant to Health and Human Services regulations for compliance under Title III of the ADA, the Rehabilitation Act of 1973, and the non-discrimination requirements of Section 1557 of the Affordable Care Act. We can assist with any questions regarding the required policies and other issues as to compliance with the ADA, the Rehab Act and Section 1557.
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Don’t let the facts get in the way and interfere with your agenda
I asked www.perplexity.ai the following fairly (IMO) complex question. It looked at 58 different sources to come up with this answer/explanation. It has been several years since the DEA has published what they were spending to fight the war on drugs. Recent estimates are that it is 120 – 140 million/yr. I have read recently that the 1970 CSA directed the DEA to deal with the diversion of pharma opioids. That might explain why we don’t see the DEA involved with all the illegal opioids and various illegal substances showing up on our streets. Our DEA is part of our FED DOJ, and they have an array of laws they are in charge of enforcing, and sometimes their interpretation(s) of the laws. Which our SCOTUS declared a year ago that Fed agencies do not have the statutory authority to make new interpretations of the laws they are in charge of enforcing. SCOTUS has no authority to enforce our laws. That is the duty of the DOJ. Unfortunately, many bureaucrats and politicians seem to work under the premise that “no one is above the law… except those who are in charge of enforcing our laws”. So, those entities that choose to enforce or ignore our laws can pretty much establish their own agenda. Their agenda prevails, and the FACTS are just ignored, and “experts” come forward to contradict and deny the facts are untrue and/or meaningless.
Most of your footnotes reference the use of opioids and treating SUD. Little/no deal with treating chronic pain. A couple of years ago the DEA stated that < 1% of pharma opioids were being diverted, but followed up by reducing pharma production quota. The National agreement was a mediated agreement – no court case. It would seem that there was no consideration of those agreements causing chronic pain patients to have access to their prescribed, medically necessary medications. Who determines what adequate pain therapy is? The vast majority of OD/poisoning is with opioids. The illegal opioids are known to be coming primarily from China & Mexican cartels. Over the last decade, pharma opioid production quotas have been reduced > 50%, and yet OD/poisoning is up 6-7 times. Are politicians & bureaucrats ignoring the real source of OD/poisoning – illegal opioids?
The opioid overdose crisis has shifted dramatically toward illicit synthetic opioids like fentanyl, yet policy and regulatory responses often lag behind this reality. Here’s an analysis of the disconnect between the current overdose drivers and policy focus:
—
### **1. Overdose Trends vs. Policy Focus**
– **Illicit opioids dominate deaths**: Over 80% of opioid-related deaths now involve illicitly manufactured fentanyl, with China supplying precursors and Mexican cartels producing/distributing the drug ([4][5][8]). Meanwhile, pharmaceutical opioid prescriptions have declined by over 50% since 2012 ([9]).
– **Policy emphasis persists on prescription opioids**: Recent settlements (e.g., 2022 distributor agreement) and 2025 DEA regulations ([3]) continue targeting pharmaceutical supply chains, despite <1% diversion rates for prescription opioids ([8]). These policies risk restricting access for chronic pain patients without addressing the primary overdose driver: illicit fentanyl.
—
### **2. Chronic Pain Patient Challenges**
– **Stricter quotas and oversight**: The DEA’s 2025 opioid production quotas and CMS care coordination edits (90 MME/day threshold) prioritize reducing prescription volumes ([3]). However, guidelines still emphasize **individualized care**, noting opioids may be appropriate for some chronic pain patients when benefits outweigh risks ([1][2]).
– **Documentation burdens**: Physicians face increased administrative requirements to justify opioid therapy, which can delay or deter treatment for legitimate patients ([1]).
—
### **3. Political and Regulatory Blind Spots**
– **Partisan divides**:
– **Democrats** increasingly focus on pharmaceutical accountability and treatment access ([10]), which risks overemphasizing prescription opioids’ role.
– **Republicans** prioritize border security and illicit drug interdiction ([10]), but underfund harm reduction strategies (e.g., naloxone distribution, overdose prevention centers) proven to save lives ([6][7]).
– **International policy gaps**: While China and Mexico are central to fentanyl production, U.S. efforts to disrupt supply chains remain inconsistent. China’s 2019 fentanyl ban reduced direct exports but not precursor flows, and Mexican enforcement varies by administration ([4][5][8]).
—
### **4. Data vs. Action**
– **Overdose deaths vs. prescription trends**: Between 2012 and 2025:
– Pharmaceutical opioid prescriptions dropped by ~60% ([3][9]).
– Overdose deaths increased 6-7x, driven by illicit fentanyl ([7][8]).
– **Misaligned solutions**: Funding from opioid settlements often supports law enforcement rather than addiction treatment or pain management programs ([7][10]). For example, only 12% of settlement funds in 2023–2024 were allocated to harm reduction or patient care ([7]).
—
### **5. Who Decides “Adequate Pain Therapy”?**
– **Guidelines vs. reality**: The CDC’s 2022 guidelines ([2]) and state policies ([1]) delegate decisions to clinicians but impose structural barriers (e.g., dosage caps, prior authorization). This creates a “chilling effect,” where physicians avoid opioids even for appropriate cases due to liability concerns.
– **Patient exclusion**: Chronic pain advocacy groups report being sidelined in policy discussions, with settlement negotiations ([3][8]) and legislation ([10]) prioritizing public health agencies and law enforcement over patient representatives.
—
### **Conclusion**
Politicians and regulators are disproportionately focused on legacy issues tied to prescription opioids, despite overwhelming evidence that illicit fentanyl drives the overdose crisis. Chronic pain patients face collateral damage from restrictive policies, while harm reduction and international supply-chain interventions remain underprioritized. Effective solutions require:
– Reallocating settlement funds to **patient access programs** and **illicit drug interdiction**.
– Pressure on China and Mexico to disrupt precursor networks ([4][8]).
– Revisiting CDC/DEA guidelines to prevent nonmedical opioid use without penalizing legitimate patients ([1][2][3]).
Until policymakers confront the synthetic opioid pipeline and balance supply-side enforcement with patient-centered care, overdose rates will likely remain elevated.
Citations:
[1] https://www.mbc.ca.gov/Download/Publications/pain-guidelines.pdf
[2] https://www.cdc.gov/overdose-prevention/hcp/clinical-guidance/recommendations-and-principles.html
[3] https://titangroupdea.com/blog/new-opioid-regulations-pain-management-specialists-need-to-know-about-2025?hsLang=en
[4] https://www.brookings.edu/articles/the-fentanyl-pipeline-and-chinas-role-in-the-us-opioid-crisis/
[5] https://www.npr.org/2025/02/02/nx-s1-5283957/fentanyl-trump-tariffs-china-canada-mexico
[6] https://www.thinkglobalhealth.org/article/how-overdose-prevention-centers-became-political-scapegoats
[7] https://www.npr.org/2023/12/28/1220881380/overdose-fentanyl-drugs-addiction
[8] https://www.cfr.org/backgrounder/fentanyl-and-us-opioid-epidemic
[9] https://pmc.ncbi.nlm.nih.gov/articles/PMC5565130/
[10] https://ldi.upenn.edu/our-work/research-updates/partisan-politics-and-the-opioid-epidemic-a-social-media-analysis/
[11] https://www.humhealth.com/blog/chronic-pain-management-cpt-codes-and-billing-guide-2025/
[12] https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
[13] https://www.aafp.org/family-physician/patient-care/care-resources/pain-management/aafp-chronic-pain-management-toolkit.html
[14] https://docrx.com/2025-billing-updates-for-non-opioid-pain-treatments-key-takeaways-for-healthcare-providers/
[15] https://www.ncbi.nlm.nih.gov/books/NBK92054/
[16] https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/opioid-prescribing.html
[17] https://nacns.org/wp-content/uploads/2025/02/Pain-Management_2025_02_04_FINAL-.pdf
[18] https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/appendix-b-state-by-state-summary.pdf
[19] https://end-overdose-epidemic.org/wp-content/uploads/2020/07/Principles-of-Evidence-Informed-Pain-Care-FINAL_template-1.pdf
[20] https://painmed.org/clinical-guidelines/
[21] https://www.ncbi.nlm.nih.gov/books/NBK572085/
[22] https://www.ncbi.nlm.nih.gov/books/NBK553030/
[23] https://www.ncbi.nlm.nih.gov/search/research-news/19707
[24] https://www.congress.gov/event/118th-congress/house-event/115371/text
[25] https://www.dea.gov/sites/default/files/2020-03/DEA_GOV_DIR-008-20%20Fentanyl%20Flow%20in%20the%20United%20States_0.pdf
[26] https://www.wilsoncenter.org/article/lab-overdose-synthetic-opioid-crisis-shaping-us-mexico-agenda
[27] https://www.dea.gov/sites/default/files/2024-05/NDTA_2024.pdf
[28] https://www.pa.gov/agencies/ddap/overdose/opioid-overdose.html
[29] https://www.cbp.gov/border-security/frontline-against-fentanyl
[30] https://www.samhsa.gov/find-help/helplines/national-helpline
[31] https://www.whitehouse.gov/presidential-actions/2025/02/imposing-duties-to-address-the-flow-of-illicit-drugs-across-our-national-border/
[32] https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates
[33] https://fsi.stanford.edu/sipr/fentanyl-blame-game
[34] https://www.dea.gov/resources/facts-about-fentanyl
[35] https://pmc.ncbi.nlm.nih.gov/articles/PMC9838196/
[36] https://www.azag.gov/issues/opioids
[37] https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html
[38] https://www.naccho.org/programs/community-health/injury-and-violence/overdose/health-equity-drug-overdose-response
[39] https://www.hhs.gov/overdose-prevention/
[40] https://www.cbo.gov/publication/58532
[41] https://siepr.stanford.edu/publications/policy-brief/opioid-crisis-tragedy-treatments-and-trade-offs
[42] https://calmatters.org/explainers/california-opioid-crisis/
[43] https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2022/01/07/an-equitable-response-to-the-ongoing-opioid-crisis
[44] https://journalofethics.ama-assn.org/article/how-fda-failures-contributed-opioid-crisis/2020-08
[45] https://publichealth.jhu.edu/2024/nearly-one-third-of-us-adults-know-someone-whos-died-of-drug-overdose
[46] https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
[47] https://www.asahq.org/~/media/sites/asahq/files/public/resources/standards-guidelines/practice-guidelines-for-chronic-pain-management.pdf
[48] https://www.dir.ca.gov/dwc/DWCPropRegs/2025/MTUS-Evidence-Based-Update/Chronic-Pain-Guideline.pdf
[49] https://www.va.gov/painmanagement/docs/cpg_opioidtherapy_summary.pdf
[50] https://www.healthquality.va.gov/guidelines/pain/cot/
[51] https://nida.nih.gov/research-topics/opioids
[52] https://www.bbc.com/news/articles/cvg93nn1e6go
[53] https://www.canada.ca/en/health-canada/services/opioids/overdose.html
[54] https://medlineplus.gov/opioidoverdose.html
[55] https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0236815
[56] https://pmc.ncbi.nlm.nih.gov/articles/PMC9261968/
[57] https://www.ama-assn.org/system/files/ama-overdose-epidemic-report.pdf
[58] https://pmc.ncbi.nlm.nih.gov/articles/PMC5846593/
—
Answer from Perplexity: pplx.ai/share
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Once Again, NO ONE is above the law – except those who are in charge of enforcing such laws
Please read Mark’s letter below.. Mark reached out to me some 8-9 yrs ago as the MT medical board was starting to “go after him.”
As I understand it, one or more large practices in Maine have decided that all pain pts will be treated with Buprenorphine for pain management.
In Reading the Maine’s Pain Management Policies. It would seem that -collectively – Maine’s legal and healthcare professionals are violating their own law in regards to at least Brandy.
Opioid Prescribing Limits**: Maine’s 2017 law restricts opioid prescriptions to ≤100 morphine milligram equivalents (MME)/day for chronic pain, with exceptions for palliative care, cancer, and substance use disorder treatment
Here is: Maine’s Pain Management Policies
Maine’s approach to pain management does not mandate the universal use of buprenorphine for all pain patients, but its regulations encourage cautious opioid prescribing while allowing flexibility for evidence-based treatments. The literature supports buprenorphine’s efficacy in managing chronic pain, particularly in high-intensity cases, with studies showing sustained pain relief and reduced tolerance development. For patients with high CYP-450 metabolism, pharmacokinetic interactions are manageable and rarely clinically significant.
### Maine’s Pain Management Policies
– **Opioid Prescribing Limits**: Maine’s 2017 law restricts opioid prescriptions to ≤100 morphine milligram equivalents (MME)/day for chronic pain, with exceptions for palliative care, cancer, and substance use disorder treatment[1].
– **Non-Opioid First Approach**: Clinicians must prioritize non-opioid therapies and use “Universal Precautions” (risk assessment, monitoring) when prescribing controlled substances[2][3].
– **Buprenorphine in Practice**: While not explicitly mandated, buprenorphine is permitted under exceptions for medication-assisted treatment (MAT) and chronic pain[1][3].
### Buprenorphine’s Efficacy in Pain Management
– **Chronic Pain**:
– A 36-month study of transdermal buprenorphine patches demonstrated sustained pain reduction (NRS scores decreased by 4.2–5.1 points) and high patient satisfaction (PGIC scores improved by 76%)[5].
– Systematic reviews found buprenorphine rotation from full opioids maintained or improved analgesia in 53–83% of patients, with fewer adverse effects than traditional opioids[10].
– **High-Intensity Pain**:
– Perioperative protocols recommend continuing buprenorphine and supplementing with short-acting opioids for acute pain, as abrupt discontinuation risks withdrawal[4].
– Partial agonism at µ-opioid receptors provides a “ceiling effect,” reducing respiratory depression risk while maintaining analgesia[11].
### CYP-450 Metabolism Considerations
– **Pharmacokinetics**: Buprenorphine is metabolized primarily by CYP3A4 and CYP2D6, with inhibitory effects on both enzymes[6][7][13].
– **Drug Interactions**:
– **Inhibitors (e.g., ciprofloxacin)**: Increase buprenorphine exposure by 33–44% but are unlikely to require dose adjustments[8][12].
– **Inducers (e.g., rifampin)**: Reduce exposure by 28%, which may necessitate monitoring[8].
– **High/Ultra-High Metabolizers**: Limited data suggest therapeutic doses remain effective, as buprenorphine’s high receptor affinity offsets rapid metabolism[6][8].
### Key Recommendations
1. **Chronic Pain**: Consider transdermal buprenorphine for long-term management due to its stable efficacy and low tolerance risk[5][10].
2. **CYP-450 Interactions**: Monitor patients on concurrent CYP3A4 inhibitors/inducers, though dose adjustments are rarely needed[8][12].
3. **Acute Pain**: Maintain buprenorphine and add short-acting opioids rather than discontinuing therapy[4].
Buprenorphine’s pharmacological profile and clinical evidence position it as a safer alternative to full opioids, aligning with Maine’s emphasis on risk mitigation without compromising pain control.
Citations:
[1] https://academic.oup.com/ajhp/article/73/12/854/5101528
[2] https://regulations.justia.com/states/maine/02/380/chapter-21/section-380-21-4/
[3] https://www.maine.gov/boardofnursing/laws-rules/Chapter%2021%2005.27.20.pdf
[4] https://www.painphysicianjournal.com/current/pdf?article=NTAwMQ%3D%3D&journal=109
[5] https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2024.1454601/full
[6] https://pubmed.ncbi.nlm.nih.gov/12756210/
[7] https://www.jstage.jst.go.jp/article/bpb/25/5/25_5_682/_pdf
[8] https://pubmed.ncbi.nlm.nih.gov/33750027/
[9] https://www.themainewire.com/2025/02/mainecare-spending-on-suboxone-has-surged-since-2019/
[10] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784021
[11] https://en.wikipedia.org/wiki/Buprenorphine
[12] https://www.drugs.com/drug-interactions/buprenorphine-with-ciprofloxacin-438-0-672-0.html?professional=1
[13] https://go.drugbank.com/drugs/DB00921
[14] https://www.maine.gov/sos/cec/rules/10/144/ch101/c2s089.docx
[15] https://library.samhsa.gov/sites/default/files/pep21-06-01-002.pdf
[16] https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/me-sud-care-initiative-midpoint-assessment-03282024.pdf
[17] https://mesudlearningcommunity.org/wp-content/uploads/2023/02/Prior-Authorization-Processes-Buprenorphine-FAQ-July2021.pdf
[18] https://lawatlas.org/sites/default/files/2025-03/VS%20Buprenorphine%20Policy%20Brief_March2025_final_3.26.25.pdf
[19] https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/appendix-b-state-by-state-summary.pdf
[20] https://www.maine.gov/boardofnursing/news.html?id=10822550
[21] https://www.mainehealth.org/care-services/behavioral-health-care/substance-use-disorder-care-addiction/opioid-use-disorder-care-mainehealth-behavioral-health/opioid-provider-resources-mainehealth-behavioral-health
[22] https://www.samhsa.gov/substance-use/treatment/find-treatment/buprenorphine-practitioner-locator
[23] https://www.federalregister.gov/documents/2025/01/17/2025-01049/expansion-of-buprenorphine-treatment-via-telemedicine-encounter
[24] https://www.mainehealth.org/health-care-professionals/clinical-guidelines-protocols/substance-use-disorder-clinical-guidelines
[25] https://pmc.ncbi.nlm.nih.gov/articles/PMC8163969/
[26] https://pmc.ncbi.nlm.nih.gov/articles/PMC8567798/
[27] https://pcssnow.org/wp-content/uploads/2022/03/PCSS-GuidanceTreatmentOfAcutePainInPatientsReceivingBup.Fiellin-SrivastavaUpdate_03_24_22.pdf
[28] https://www.ncbi.nlm.nih.gov/books/NBK459126/
[29] https://www.dovepress.com/frontline-perspectives-on-buprenorphine-for-the-management-of-chronic–peer-reviewed-fulltext-article-JMDH
[30] https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/phar.2676
[31] https://academic.oup.com/painmedicine/article-abstract/25/12/691/7716541
[32] https://academic.oup.com/painmedicine/article/21/4/714/5699282
[33] https://www.va.gov/formularyadvisor/DOC_PDF/CRE_Buprenorphine_for_Chronic_Pain_MAR_2024.pdf
[34] https://www.tandfonline.com/doi/full/10.2217/pmt-2020-0013
[35] https://pmc.ncbi.nlm.nih.gov/articles/PMC4675640/
[36] https://pmc.ncbi.nlm.nih.gov/articles/PMC4283787/
[37] https://www.recoveryanswers.org/research-post/tried-true-methadone-shows-superiority-buprenorphine/
[38] https://www.tandfonline.com/doi/full/10.1080/00325481.2016.1128307
[39] https://www.oaepublish.com/articles/jtgg.2020.35
[40] https://www.bccsu.ca/wp-content/uploads/2022/06/Buprenorphine-Naloxone-Drug-Drug-Interactions.pdf
[41] https://www.jstage.jst.go.jp/article/bpb/25/5/25_5_682/_article/-char/en
[42] https://academic.oup.com/cid/article/43/Supplement_4/S216/282268
[43] https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.271
[44] https://legislature.maine.gov/legis/statutes/22/title22sec3174-UU.pdf
[45] https://micismaine.org/wp-content/uploads/2019-MICIS-Opioid-Law-Presentation-11.2019.pdf
[46] https://www.samhsa.gov/substance-use/treatment/statutes-regulations-guidelines/mat-act
[47] https://mainedrugdata.org/focus-area-2023-2025-treatment/
[48] https://pubmed.ncbi.nlm.nih.gov/38340973/
[49] https://pmc.ncbi.nlm.nih.gov/articles/PMC7709797/
—
Answer from Perplexity: pplx.ai/share
To whom it may concern:
Filed under: General Problems | 3 Comments »
War on Doctors: Tricks Used in Prosecutions
War on Doctors: Tricks Used in Prosecutions
https://aapsonline.org/war-on-doctors-tricks-used-in-prosecutions/
This is a very long article about how our federal judicial system functions in getting any “targeted prescriber” convicted. To boil down their basic tactics… they raid and shut down a prescriber’s practice and confiscate all the prescriber’s assets under our Civil Asset Confiscation law. This leaves the prescriber with no income and no assets to hire an excellent law firm to defend the prescriber and maybe get the prescriber found not guilty. I remember a particular prescriber in Montana who – as I remember – was charged with 400 counts over the patient records of 9 patients. Each count was worth a 20 yr prison sentence. The prescriber ended up using a PUBLIC DEFENDER and ended up pleading guilty to a single charge and ended up with a 20 yr prison term.
Dr. Chris Arthur Christensen, 68 y/o, a physician from Montana, was convicted and sentenced to prison for multiple violations of the Controlled Substances Act. His case involved serious allegations of improper medical practices, including the overprescribing of narcotics.
In 2015, Dr. Christensen faced 400 felony charges, including two counts of negligent homicide related to patient overdoses, nine counts of criminal endangerment, and hundreds of counts of illegal drug distribution. Investigators alleged that he prescribed controlled substances outside the scope of legitimate medical practice and operated a “cash-only” clinic that attracted patients from multiple states. Two patients reportedly died from overdoses linked to his prescriptions[1][2].
After a trial in 2017, Dr. Christensen was convicted on several counts, though his negligent homicide convictions were later overturned by the Montana Supreme Court due to insufficient evidence directly linking his actions to the deaths. However, the court upheld other convictions, including criminal endangerment and illegal drug distribution, as it found he was operating outside the bounds of professional medical standards[3].
In 2018, he was sentenced to 20 years in prison, with 10 years suspended. Following appeals, he began serving his sentence in November 2020[2].
Citations:
[1] https://www.dea.gov/es/node/4327
[2] https://doctorsofcourage.org/chris-a-christensen-md/
[3] https://law.justia.com/cases/montana/supreme-court/2020/da-18-0268-0.html
[4] https://www.casemine.com/commentary/us/montana-supreme-court-upholds-criminal-liability-for-physicians’-unlawful-drug-distribution-practices/view
[5] https://www.kpax.com/news/ravalli-county/former-florence-doctor-finally-behind-bars-4-years-after-conviction
[6] https://juddocumentservice.mt.gov/getDocByCTrackId?DocId=306890
[7] https://caselaw.findlaw.com/court/mt-supreme-court/2085987.html
[8] https://doctorsofcourage.org/chris-a-christensen-md-2/
[9] https://bitterrootstar.com/2020/09/montana-supreme-court-overturns-christensens-homicide-convictions/
[10] https://flatheadbeacon.com/2020/11/23/convicted-montana-pain-doctor-ordered-prison-march/
[11] https://medicalmalpracticelawyers.com/montana-supreme-court-overturns-negligent-homicide-convictions-of-opioid-prescribing-doctor/
[12] https://www.spokesman.com/stories/2020/sep/16/justices-overturn-doctors-convictions-in-overdose-/
[13] https://scholarworks.umt.edu/cgi/viewcontent.cgi?article=2497&context=mlr
[14] https://bitterrootstar.com/2017/11/guilty-verdict-in-opioid-over-prescription-case-an-analysis/
Answer from Perplexity: pplx.ai/share
By Andrew L. Schlafly, Esq.,
“Show me the man and I’ll find you the crime” is a famous saying from the communist Soviet Union, where prosecutions of innocent people, and over-prosecutions of people for minor infractions, were routine.
Similar sayings have existed in the United States, as in how a prosecutor can persuade a grand jury to “indict a ham sandwich.”1 (Ironically, the judge who coined that expression was himself later indicted.) As any prosecutor can confirm, if a grand jury appears reluctant to issue an indictment requested by a prosecutor, then he can simply convene another grand jury, and then another, until he gets the indictment he wants.
So much for the safeguard of the grand jury as supposedly guaranteed by the Fifth Amendment to the U.S. Constitution: “No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a grand jury.” The grim reality is that many prosecutors today have virtually unlimited power to decide whom to indict, with no meaningful check and balance by any grand jury. Occasionally there is news about a grand jury declining to indict someone in a high-profile case, such a shooting by police of an unarmed minority teenager, but even those decisions not to indict are typically the result of the prosecutor intentionally leading the grand jury to that conclusion. In cases where there is a public outcry and the prosecutor does not feel the evidence justifies a criminal indictment, then he can lead the grand jury to non-indictment, and the public is better mollified by such a decision by a grand jury than by a solitary prosecutor. But whenever a prosecutor wants an indictment against someone, then he will get it, as any prosecutor would confirm privately.
State and Federal Systems
The U.S. Constitution established a system of dual sovereignty, with the federal and state governments wielding power over their overlapping spheres of authority. Supreme Court Justice Anthony Kennedy asserted in a landmark case that the dual sovereignty enhances liberty, but many would dispute that. “Though on the surface the idea may seem counter-intuitive, it was the insight of the Framers that freedom was enhanced by the creation of two governments, not one.”2
In fact, the dual sovereignty means that the federal government can prosecute a defendant even after he was acquitted in state court for the very same conduct, despite the prohibition by the Double Jeopardy Clause in the Fifth
Amendment to the U.S. Constitution: “…nor shall any person be subject for the same offence to be twice put in jeopardy of life or limb.” A physician who is acquitted of a crime in state court could still be prosecuted for the same conduct in federal court, and it is important to be aware of fundamental differences between the two systems.
Originally, state court is where virtually all crimes were tried. “The Constitution grants the federal government jurisdiction over only three crimes: treason, counterfeiting, and piracy,”3 as Texas Rep. Ron Paul, M.D., famously observed on the floor of the U.S. House of Representatives. Everything else was tried exclusively in state court for most of American history.
In state and local government, there is a check on that power in the form of political accountability for the prosecutor, and in the form of real limitations on the resources available. District Attorney offices are not overflowing with spare staff and extra funding, and local police do not have the time or interest in pursuing nonexistent crimes. Out of political and economic necessity, real crimes take priority over political agendas. Prosecutors who overstep their role can be held accountable for it, as prosecutor Michael Nifong was for his role in the wrongful indictments of three Duke University lacrosse players for rape.
Additional factors tend to limit overzealous prosecution at the local or state level. Local prosecutors are part of the community in which they work, and many of them grew up there. They have long-time acquaintances in the neighborhood on both sides of the law. These local prosecutors are typically not seeking publicity to propel an ambition to run for higher office, which might induce them to seek targets for political purposes. Of course, there are some instances of prosecutorial abuse of power within the state and local system, as the Duke lacrosse case illustrated. Physicians too, such as Dr. James Graves in Florida, languish in prison for decades, possibly the rest of their lives, as victims of a local prosecution that made them a scapegoat for a tragedy, often, as in the Dr. Graves case, related to drug abuse.
But many so-called“healthcare crimes” and other offenses are prosecuted in federal, not state courts today, contrary to the text of the U.S. Constitution. Federal prosecutions lack the essential checks and balances in the state system, and it is at the federal level at which the War on Doctors is at its worst. Resources available for these prosecutions are virtually unlimited, and there is almost no political accountability for overstepping reasonable bounds. Federal prosecutors are appointed, not elected, and have never been impeached by Congress, although they could be. The only elected person in the chain of command of a federal prosecutor is the President, and no presidential election is likely to have its outcome determined based on the track record of a federal prosecutor.
An example of a widely criticized federal prosecution was the case against Aaron Swartz, a prodigy who while still a teenager had helped develop the widely used RSS service for individualized news feeds, and also Reddit, the immensely popular informational website.4 Aaron is no longer with us because the full weight and unlimited resources of federal prosecutors hounded him relentlessly, with threats of lengthy prison sentences, until he committed suicide shortly before trial. This was all because he had allegedly downloaded numerous copyrighted scientific articles at MIT, which he arguably had a right to do. As Professor Lawrence Lessig explained in a heartfelt criticism of the federal prosecution of Aaron:
The “property” Aaron had “stolen,” we were told, was worth “millions of dollars” — with the hint, and then the suggestion, that his aim must have been to profit from his crime. But anyone who says that there is money to be made in a stash of ACADEMIC ARTICLES is either an idiot or a liar. It was clear what this was not, yet our government continued to push as if it had caught the 9/11 terrorists red-handed [emphasis in original].5
Yet there was no political accountability for the federal prosecutors who perpetrated this, or the trial judge who allowed it. Unlike the state system, in which both face elections and other meaningful review of their records, federal criminal justices are insulated from political accountability.
With less publicity than the federal injustice against, and then tragedy of Aaron Swartz, numerous physicians have also felt compelled to commit suicide when trapped in the vise of overzealous federal prosecution. Benjamin R. Moore, D.O., for example, had been working in locum tenens for 7 years when he was placed by an agency in a temporary job at a chronic pain center in Myrtle Beach, S.C. Dr. Moore was the most conservative prescriber of opiates there, according to a letter he sent without avail to the U.S. Attorney General.6 It did not matter. Federal prosecutors went after numerous physicians in the clinic and charged them with conspiracy to distribute illegal drugs, which makes each defendant legally responsible for the actions of every other defendant. Another physician, Deborah Bordeaux, M.D., who had been working there for only 57 days, was initially sentenced to 8 years in jail, although she was fortunate enough to have the term reduced later in an unusual re-sentencing.7 Dr. Moore committed suicide before trial.
Many victims of overzealous prosecution in the federal system feel compelled to accept plea bargains or commit suicide, regardless of their guilt, because the odds of conviction in a federal trial are so high, and the prison sentences are so long if a jury does not acquit on each and every count of an indictment. Unlike state court, where the odds of acquittal are substantial, in federal court the likelihood of an acquittal on all counts is only about one percent of all federal prosecutions brought.
Typically, federal prosecutors will pile on dozens or even hundreds of counts against a physician, and the jury may think it is holding mostly for the physician if it acquits on most of the charges. But the prison sentence is just as long if a jury convicts on only one count out of 150 counts as if it had convicted on every count.
One federal prosecutor publicly declared that his office sought “to root out [certain doctors] like the Taliban. Stay tuned.”8 But physicians are not flying airplanes into the World Trade Center. Physicians are, however, much easier to prosecute than real criminals are. Physicians tend to cooperate with investigations, and will even readily admit shortcomings about their record-keeping or dealings with patients. Unlike real drug dealers, physicians trust undercover agents who wear wires attempting to entrap the target. Physicians also tend to consent to searches of their offices even when a government agent lacks a warrant.
The clincher for making physicians a top target for federal prosecutors is this: indicting a physician grabs bigger headlines than indicting a real criminal does. The fall of a good man makes for a story that is scintillating to the public. More than a century ago Fyodor Dostoyevsky observed this same phenomenon in The Brothers Karamazov: “Man loves to see the downfall and disgrace of the righteous.”9 The suggestion that a physician, a man of great trust in society, may actually be a horrific criminal is something that sells newspapers and attracts television viewers. The physician used his position of trust to exploit unsuspecting patients, the story goes, and a white knight in the form of a prosecutor protected society against the scoundrel by locking him up and throwing away the key.
If the physician were a real criminal, the case would be easy to prove, and it would not be necessary for a prosecutor to resort to any tricks to achieve his goal. Undercover sting operations, for example, would hardly be necessary if a physician were truly exploiting his position.
Trial by Jury
A brief history of trial by jury is necessary for readers to understand the tactics prosecutors use against physicians.
Jury trials are nearly unique to the Anglo-American system of jurisprudence, dating back to 13th-century England. Trial by jury originated not as improvement over trial by judge, but to replace the outdated approaches of “compurgation” or “ordeal.” Under “compurgation,” a defendant could be acquitted of an accusation by obtaining a sufficient number of sworn statements by members of the community to support him. The “ordeal,” as its name implies, was less pleasant. It required the accused to stick his hand into a pot of boiling water to pick out a stone, while in the presence of clergy, and afterward his wound was observed for several days. The idea was seek divine intervention to give a sign as to guilt or innocence depending on how the wound festered or healed. By the 1200s the Church banned participation by clergy in this inhumane process, which was being used rarely and only for the most heinous alleged crimes anyway.
The rationale for switching to trial by jury was to give the community a voice in determination of guilt or innocence, as the community (or God) were supposed to have in the ancient methods of compurgation and ordeal. All these methods contain an element of arbitrariness, some might say. Juries were not initially considered to be any more reliable, consistent, or rational than the approaches that trial by jury replaced. But juries are to speak with the voice of the community, or neighborhood, and to express their view with unanimity in order to convict.
The primary reason that the right to a trial by jury is in the U.S. Constitution, however, is because juries provide an essential check against overzealous prosecutions by government. It was a jury that established the foundation for our First Amendment, in the criminal libel case brought against John Peter Zenger in 1735 for defaming the governor of New York, William Cosby.10 That remarkable jury trial also set the precedent for the American doctrine that truth is an absolute defense against a charge of defamation. Zenger in his New York Weekly Journal had published some highly critical assertions against the powerful governor, who then brought the full power of his government down on Zenger in retaliation. Truth was not recognized as a defense against a charge of criminal defamation at that time, and conviction seemed inevitable. But Zenger’s lawyers Andrew Hamilton and William Smith, Sr., argued successfully, the jury acquitted Zenger, and American freedom of the press was born as a result.
Note that the Founders did not believe in democracy and never thought that the collective opinion of random members of society would yield the correct answer to every question. Quite the contrary, the Founders were very skeptical of the public being able to do what is right and just. The Founders include a “right” to a jury trial for the benefit of an accused, not a “requirement” of a jury trial. Then, as now, ordinary people are vulnerable to the influences of demagoguery, prejudice, and careless error, as the Founders were well aware.
No Right to a Trial by a Judge?
The Constitution’s Sixth Amendment states:
In all criminal prosecutions, the accused shall enjoy the right to a speedy and public trial, by an impartial jury of the State and district wherein the crime shall have been committed, which district shall have been previously ascertained by law, and to be informed of the nature and cause of the accusation; to be confronted with the witnesses against him; to have compulsory process for obtaining witnesses in his favor, and to have the Assistance of Counsel for his defence.11
This establishes a right, not a requirement, to have a jury trial.
In addition, the body of the original Constitution contains the following at Art. III, § 2:
The Trial of all Crimes, except in Cases of Impeachment, shall be by Jury; and such Trial shall be held in the State where the said Crimes shall have been committed; but when not committed within any state, the Trial shall be at such Place or Places as the Congress may by Law have directed.
This provision, although ostensibly requiring trial by jury in cases brought in federal court for the three crimes that the U.S. Constitution allowed the federal government to prosecute, is again obviously intended to protect the rights of the accused, not to protect the power of government.
In colonial America, defendants were able to waive their right to a jury trial in many areas, and in Maryland the prevailing standard for 150 years was to hold criminal trials before a judge rather than a jury. In 1930, the U.S. Supreme Court held in Patton v. United States that a criminal defendant has a right to waive trial by jury, but then the Court unjustifiably added that “before any waiver can become effective, the consent of government counsel and the sanction of the court must be had, in addition to the express and intelligent consent of the defendant.”12
Intuitively, most criminal defendants think they are better off with a jury hearing their case. The instinctive reaction of nearly everyone is to exercise their rights, as one might exercise his right to free speech when faced with an injustice.
But studies have shown that some defendants are better off choosing a trial before a judge than a jury, and clever attorneys realize that a trial by judge might be fairer than a trial by jury, particularly when the government is relying on demagoguery to advance its case. As the next section explains, the government is increasingly relying on arguments designed to inflame prejudice against physicians, rather than sticking only to facts relevant to a claim of wrongdoing.
The Federal Rules of Criminal Procedure states in its Rule 23 that:
- Jury Trial. If the defendant is entitled to a jury trial, the trial must be by jury unless:
- the defendant waives a jury trial in writing; (2) the government consents; and (3) the court
In other words, the Federal Rules deny a criminal defendant his right to have a non-jury criminal trial unless both the prosecutor and the court itself consent to the defendant’s request.
The constitutionality of requiring a criminal defendant to have a jury trial was subsequently tested and decided in an unfortunate way. A defendant was convicted of a mail fraud scam “to dupe amateur songwriters into sending him money for the marketing of their songs,” and the defendant appealed on this issue as a way to get out of his conviction.13 He requested a non-jury trial “for the purpose of shortening the trial,” rather than for a weightier reason such as to avoid prejudice against him by the jury. This case reached the
- Supreme Court in 1964, when defendant-friendly Chief Justice Earl Warren was presiding, but he failed to recognize and address the significance of the issue. The “Warren Court,” as it was called, rendered many major decisions in favor of defendants, but missed its opportunity this
Writing for the Court, Chief Justice Warren correctly observed that criminal trials by jury were common at the time of the ratification of the Sixth Amendment. But evidently jury trials were not universal, or else there would have been little reason for the Founders to include the protection of a right to a jury trial. In missing obvious truths universally acknowledged with respect to other parts of the Constitution, such as how the right to free speech necessarily entails the right not to speak, the Court ruled that a constitutional right to have a jury trial does not imply a right not to have a jury trial.
The Court first recounted several compelling arguments for a right to be able to waive a trial by jury:13, pp 25-26
- “At common law the right to refuse a jury trial preceded the right to demand ”
- “Both before and at the time our Constitution was adopted criminal defendants in this country had the right to waive a jury ”
- “The provisions [in the Constitution] relating to jury trial are for the protection of the ”
- “Since a defendant can waive other constitutional rights without the consent of the Government, he must necessarily have a similar right to waive a jury trial and that the Constitution’s guarantee of a fair trial gives defendants the right to safeguard themselves against possible jury prejudice by insisting on a trial before a judge ”
- “The Fifth, Sixth, Ninth, and Tenth Amendments are violated by placing conditions on the ability to waive trial by ”
Yet the Warren Court rejected all the above arguments and held that both a federal prosecutor and the court itself each has a veto right over a defendant’s attempt to waive a trial by a jury that may be prejudiced against him.
Accordingly, federal prosecutors know that they can always insist on a trial by jury, and they tailor their prosecutorial strategy accordingly. Irrelevant or inflammatory arguments that should never persuade a judge could potentially mislead a jury to convict. With that in mind, we turn to the latest tricks and traps in the prosecutions of physicians.
Tricks and Traps in Prosecutions of Physicians
“Just the facts, ma’am,” is the famous phrase attributed to Sgt. Joe Friday, the detective played by Jack Webb in the popular TV series Dragnet that portrayed law enforcement in glowing light in the 1950s and 1960s. If prosecutors of
physicians properly stuck to“just the facts,”unjust convictions and unfair plea bargains would be less frequent.
Unfortunately, some prosecutors go beyond the relevant facts in their quest for convictions, based on the end justifying the means. According to the utilitarian mindset that is increasingly common in the federal criminal justice system, why does it matter whether the defendant is really guilty or not? The stated purpose of the prosecution and lengthy sentencing is to deter wrongdoing, and that goal is met whether a guilty or an innocent man is locked up. As long as the public is persuaded that a crime occurred, and as long as the public is told that the criminal was caught and severely punished, the desired effect of deterrence is satisfied regardless of the underlying innocence of the man imprisoned.
Prosecutions of physicians today are typically accompanied by harsh public statements made by the government against the defendant physician. A recent news story about the federal prosecution of a Eugene J. Gosy, M.D., in the Buffalo area illustrates several tricks used in the war on doctors.14
- Statistical profiling: “He was the No. 1 prescriber in New York,” declared an agent in charge of the DEA’s office in Buffalo, to the press. The fallacy is that there will always be a “No. 1 prescriber in New York.”Why should that statistic shock anyone? Yet it does tend to prejudice the average person who hears After prosecutors destroy the No. 1 prescriber in a state, then the No. 2 prescriber will become No. 1. Will that statistic make him guilty too? Of course not. Moreover, high volume does not imply guilt. Popularity breeds more popularity, in any line of work. The company Apple is not guilty of anything because its iPhone is popular.
- Saying the doctor was “out of the country” when prescriptions were written: This allegation is a favorite of prosecutors, and we’ve seen it used again and again against They compare billing records to the physician’s passport, and check the dates against each other. The argument sparks jealously and improperly creates a picture of a supposedly cavalier attitude by the traveler. The fallacy is that nothing wrongful can be inferred about someone for merely traveling outside of the country. Sometimes that world travel is to establish contacts for medical mission trips to impoverished lands; other times the travel is merely to visit family in a foreign country. But even if the travel were pure leisure, that is not a bad thing that should be used to create prejudice. The government could simply say that the physician was not in the office, rather than smearing him by saying he was out of the country. Moreover, mistaken dates in billing records are inevitable, particularly in a high-volume practice. In a prior civil lawsuit against a physician, the government claimed he billed more than 24 hours in a day, when it was merely a mistaken billing date that was the reason.
- Trumpeting the doctor’s wealth—such as a “$126,000 Ferrari and a $103,000 Ford GT coupe”: The government seized these assets and apparently told the newspapers all about it, so it was featured prominently in the publicity against the physician. The fallacy is that it is not a crime for a successful practicing physician to earn money and spend it on a nice car or two. The type of car that a physician drives is not evidence of any wrongdoing. Prosecutors commonly exploit class warfare in their war on doctors. The government wants to portray the physician as obscenely wealthy and incredibly greedy, for prejudicial effect. The reality is that practicing physicians, even the highest compensated ones, make only a pittance compared with insurance company executives, while working many times harder than executives do. An executive at a specialty society profiting from Maintenance of Certification (MOC) has publicly bragged about his rare car collection, yet the government has taken no action against him.
- Emphasizing the large sum of false claims alleged, say “more than $241,000”: Prosecutors and the newspaper report such a number as though it is shocking, but they omit the all-important The fallacy is that the absolute amount of alleged fraud is virtually meaningless unless represented as a percentage of total billings. If a physician billed $25 million over five years, then the alleged fraud of $241,000 is less than 1 percent of his billings. Error rates in most billing services are probably higher than that. By failing to disclose the denominator, the publicity fails to mention that the allegation is merely that 1 percent of his billings were fraudulent. The public would be far less impressed by an allegation of an error rate of 1 percent than by an alleged amount of $241,000.
- Mentioning that “Like [the indicted physician], five other doctors have found themselves investigated,” and two of them pled guilty: The fallacy is that physicians often plead guilty because they face life in prison, or at least 20 years, if they take a case to trial and a jury mistakenly finds them Moreover, taking a case to trial can cost millions of dollars. When innocent physicians are offered plea bargains of less than 10 percent of the lengthy prison sentences, and can avoid a million-dollar loss to their retirement assets, then innocent physicians might plead guilty. An offer of only 2 or 3 years in prison can look very good to an innocent physician whose assets have been seized and who cannot even hire a good attorney to defend himself. The guilty plea does not mean the defendant was really guilty, as the negative publicity falsely implies.
Effect on the Community
At the time of this writing, Dr. Gosy is awaiting trial with his New York medical license intact but his ability to practice crippled by the negative publicity against him and loss of his DEA registration to prescribe controlled substances. Despite the vigorous public relations effort by the government that thoroughly smeared Dr. Gosy’s reputation, the reaction by the community was swift and intensely negative against the government. Dr. Gosy was forced by the indictment to close his practice, which stranded between 8,000 and 10,000 active patients in need of pain medications. Other physicians are obviously terrified to treat them with the threat of decades in prison hanging over them if they do. “At this point, we’re at a public health crisis,” observed Dr. Gale R. Burstein, county health commissioner.15 But this prosecution is by the federal government, and federal officials have no accountability for the devastating effect this has caused to the local community.
Conclusion
The Founders would be shocked at the degree to which the federal government is pursuing prosecutions of physicians and others, and the tactics employed to attain convictions. At least physicians can become more aware of the tricks being used.
Andrew L. Schlafly, Esq., serves as general counsel to AAPS. Contact: aschlafly@aol.com.
REFERENCES
- Levin J. The judge who coined “indicting a ham sandwich” was himself indicted. Slate, Nov 25, 2014. Available at: slate.com/blogs/lexicon_ valley/2014/11/25/sol_wachtler_the_judge_who_coined_indict_a_ ham_sandwich_was_himself_indicted.html. Accessed May 27, 2016.
- United States Lopez, 514 U.S. 549, 576 (1995) (Kennedy, J., concurring).
- Paul R. Crime. Book of Ron Paul. 2000 Ron Paul 71:5. Available at: http:// ronpaulquotes.com/concordance/crime.html. Accessed May 27,
- Bombardieri The inside story of MIT and Aaron Swartz. Boston Globe, Mar 30, 2014. Available at: https://www.bostonglobe.com/metro/2014/03/29/ the-inside-story-mit-and-aaron-swartz/YvJZ5P6VHaPJusReuaN7SI/story. html. Accessed May 28, 2016.
- Lessig L. Prosecutor as bully. LESSIG Blog, v2. Available at: http://lessig.com/post/40347463044/prosecutor-as-bully. Accessed May 28, 2016.
- Moore B. Letter to Attorney General John Ashcroft. Available at: aapsonline.org/painman/mooreashcroft.htm. Accessed May 28, 2016.
- Victimized Doctors. Available at: http://deasucks.com/essays/docwar3. Accessed May 28, 2016.
- Serkes K. Administration Declares war on doctors — vows to treat like Taliban. Drug war ensnares doctors, not dealers. Press Release. Available at: aapsonline.org/press/hurwitz929.htm. Accessed May 28, 2016.
- Dostoevsky Chapter 2. The Brothers Karamazov. Translated by Constance Garnett. Available at: www.magister.msk.ru/library/dostoevs/dostf01e. htm. Accessed May 28, 2016.
- John Peter Zenger Trial; 1735. Available at: http://law2.umkc.edu/faculty/ projects/ftrials/zenger/zenger.html. Accessed May 28,
- Sixth Amendment. U.S. Constitution. Available at: http://constitution.com/amendment6.html#sthash.MNPP2yPO.dpuf. Accessed May 28, 2016.
- Patton United States, 281 U.S. 276, 312 (1930).
- Singer United States, 380 U.S. 24, 25 (1965).
- Fairbanks Amherst pain doctor faces federal charges. Buffalo News, Apr 26, 2016. Available at: www.buffalonews.com/city-region/ amherst-pain-doctor-faces-federal-charges-20160426. Accessed May 28, 2016.
- Tan ‘What are we supposed to do?’ opioid patients ask after feds shut down doctor. Buffalo News, May 5, 2016. Available at: www.buffalonews. com/city-region/what-are-we-supposed-to-do-opioid-patients-ask- after-feds-shut-down-doctor-20160505. Accessed May 28, 2016.
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Employee shot and killed at Walgreens in Madera identified
MADERA, Calif. (KFSN) — The employee who was shot and killed at a Walgreens in Madera on Monday has been identified as Erick Velasquez.
Police say the shooting happened at the location on Cleveland and Schnoor just after 9:30 pm.
EDITOR’S NOTE: The video above is from a previous broadcast and will be updated.
When police arrived, they found Velasquez inside the store, where he was pronounced dead.
Police say the suspect, Narciso Gallardo Fernandez, went to Madera from Pixley and went inside the store with a handgun.
After the shooting, police say Fernandez fired at other employees as they were leaving the store. No one else was hit.
He was taken into custody in the parking lot.
Customers were also inside the store at the time of the shooting.
Police do not believe that Velasquez and Fernandez knew each other.
Walgreens released a statement on the incident, saying, “We are deeply saddened by last night’s tragic event, which resulted in the death of one of our team members. Our thoughts and prayers are with their loved ones during this difficult time. The safety of our customers and team members is our top priority, and we are working with local authorities in their investigation.”
Anyone with more information is asked to contact police.
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When are disabled people going to get a DAY OF VISIBILITY? Where is the equity?
Today is
Transgender Day of Visibility: Honoring Trans Heroes and Sharing Stories of Resilience
According to this:
Approximately 1.6 million people in the United States identify as transgender, representing around 0.6% of the population aged 13 and older. This includes about 1.3 million adults (0.5% of the adult population) and 300,000 adolescents aged 13 to 17 (1.4% of that age group)136.
While estimates vary slightly depending on the methodology and data source, this figure is consistent across multiple studies and surveys, including those conducted by the Williams Institute and other research organizations159.
Citations:
- https://www.newsweek.com/how-many-transgender-people-athletes-living-united-states-2030241
- https://pmc.ncbi.nlm.nih.gov/articles/PMC5227946/
- https://williamsinstitute.law.ucla.edu/wp-content/uploads/Trans-Pop-Update-Jun-2022.pdf
- https://apnews.com/article/how-many-transgender-intersex-laws-0218b75a197f07d8c51620bb73495d55
- https://www.nbcmiami.com/news/local/politifact-how-many-trans-people-are-there-in-the-u-s-and-why-do-we-overestimate-it/3074621/
- https://williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/
- https://usafacts.org/articles/what-percentage-of-the-us-population-is-transgender/
- https://www.pewresearch.org/short-reads/2022/06/07/about-5-of-young-adults-in-the-u-s-say-their-gender-is-different-from-their-sex-assigned-at-birth/
- https://www.reuters.com/world/us/new-study-estimates-16-million-us-identify-transgender-2022-06-10/
Answer from Perplexity: pplx.ai/share
According to www.perplexity.ai:
The number of people in the United States considered disabled varies depending on the criteria and data source:
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Adults with Disabilities: Over 70 million adults in the U.S., or more than 1 in 4 (28.7%), reported having a disability in 2022, according to the CDC’s Behavioral Risk Factor Surveillance System17.
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All Ages (Non-Institutionalized Population): Approximately 42.5 million Americans, or 13% of the civilian noninstitutionalized population, had a disability in 2021, based on U.S. Census Bureau data310.
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Survey of Income and Program Participation (SIPP): This survey estimates that around 54 million Americans have a disability, though it uses broader definitions and methodologies4.
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Working-Age Population (18–64): About 22 million working-age Americans (11% of this demographic) reported having a disability in 2022, according to the American Community Survey5.
These figures highlight differences in how disabilities are defined and measured across various surveys and contexts.
Citations:
- https://www.cdc.gov/media/releases/2024/s0716-Adult-disability.html
- https://www.ssa.gov/policy/docs/statcomps/di_asr/2021/sect01.html
- https://www.pewresearch.org/short-reads/2023/07/24/8-facts-about-americans-with-disabilities/
- https://adata.org/faq/how-many-people-united-states-have-disability
- https://askearn.org/page/statistics-on-disability
- https://www.researchondisability.org/sites/default/files/media/2024-03/2024-annual-report-a11y-1.pdf
- https://www.cdc.gov/disability-and-health/articles-documents/disability-impacts-all-of-us-infographic.html
- https://www.census.gov/newsroom/facts-for-features/2024/disabilities-act.html
- https://miusa.globaldisabilityrightsnow.org/infographic/disability-usa/
- https://www.census.gov/library/stories/2023/06/disability-rates-higher-in-rural-areas-than-urban-areas.html
Answer from Perplexity: pplx.ai/share
Did you know that the primary FDA medication that is used by females who wish to transition to being a male? TESTOSTERONE – A C-3 CONTROLLED SUBSTANCE. The DEA – to date – has not imposed any pharma production limitations. Apparently, the only reason that it is classified as a C-3 is to try to prevent/limit athletes and bodybuilders from using it.
There is nothing that ever suggested that politicians and bureaucrats function with logic and common sense.
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Have you ever been ASKED?
Have you ever been asked by your practitioners and/or a staff member?
Have you ever considered harming yourself?
In all the years that I have been doing my blog, I now notice that the number of ESTIMATED suicide and attempted suicides published by the CDC has remained unchanged. 2012 when I started my blog, and today the USA population abt 9%. Mental health issues tend to be a rather fixed percentage of a population.
It is also interesting that around 2010-2012 is when the Rx opioids peaked, and today, the number of Rx opioids has been reduced abt 50%.
We know that many chronic pain patients have committed suicide because their pain meds have been involuntarily reduced, and an untold number of PREMATURE DEATHS from various reasons caused by under/untreated pain. While those numbers may or may not be documented, I have not seen a number being published.
Does this STRONGLY SUGGEST that there is a COVERT GENOCIDE going on?
Maybe chronic pain pts should take a copy of the graphic below with them to their doctor’s appointment?
When ASKED THE QUESTION… Suicide ideation can be caused by increased anxiety and depression, which can be caused by chronic pain pt’s pain management being forcibly reduced.
Should the chronic pain pt’s answer to THE QUESTION BE?
It may all depend on how much my pain management is reduced! Point to the bottom line on the chart! Might say something about the fact that aren’t doctors/practitioners supposed to be HEALERS? As my pain management is reduced, I can expect the average intensity of my pain to increase, and my QOL is going to be compromised. I don’t look forward to being under “house arrest” because my pain will confine me to my house, chair, or bed. The CP pt might also express their concerns about all the other comorbidity issues that may be made worse and/or cause the pt to experience NEW COMORBITIY ISSUES not top of all the comorbidity issues they are already dealing with.
Right now, I can answer the questions with a NO, but suicide is generally somewhat impulsive. As my QOL deteriorates in line with my pain management being reduced, I can’t say what tomorrow brings.
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Read this and weep – AGs and National Opioid Agreement – nicely put CPs OUT IN THE COLD
If the opioid settlement agreements result in shortages of prescription opioids for patients with legitimate medical needs, those patients may face significant challenges in pursuing legal recourse against the participants in the agreement. Here are key considerations:
1. Legal Protections for Settlement Participants
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The settlement agreements were designed to resolve litigation and include provisions that shield participating companies from future lawsuits related to their role in the opioid crisis. These protections likely extend to claims stemming from the terms of the settlement itself, such as restrictions on opioid distribution17.
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The agreements include measures like enhanced monitoring of opioid distribution and stricter controls on suspicious orders to prevent diversion, which could indirectly contribute to shortages12.
2. Challenges for Patients Seeking Recourse
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Causation: Patients would need to prove that the settlement terms directly caused their inability to access necessary opioids, rather than other factors like supply chain issues or prescribing practices.
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Intent and Liability: The agreements aim to address public health concerns by reducing opioid misuse and diversion. Courts may view these measures as reasonable efforts to combat a public health crisis, making it difficult for patients to argue negligence or harm by the participants.
3. Potential Public Health Concerns
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Shortages of prescription opioids could push some patients toward illicit alternatives, increasing risks of overdose and other harms3. This underscores the need for careful implementation of settlement terms to balance public health goals with legitimate patient needs.
4. Alternative Avenues for Patients
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Patients facing shortages may be able to advocate through healthcare providers, pharmacists, or policymakers for adjustments in distribution practices or exceptions for certain cases.
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Healthcare providers can explore alternative pain management strategies or appeal to regulatory agencies if shortages become widespread and harmful3.
In summary, while patients affected by shortages might face difficulties in holding settlement participants legally accountable, they can advocate for improved policies or seek alternative solutions within the healthcare system.
Citations:
- https://www.naag.org/issues/opioids/
- https://www.texasattorneygeneral.gov/globalopioidsettlement
- https://www.pharmacytimes.com/view/opioid-drug-shortages-affect-patients-health-systems
- https://www.naccho.org/uploads/downloadable-resources/OpioidSettlementsPDFFinal.pdf
- https://www.texasattorneygeneral.gov/news/releases/opioids-maker-teva-agrees-425-billion-settlement-preliminary-agreement-will-provide-cash-and
- https://www.ncbi.nlm.nih.gov/books/NBK458653/
- https://www.casscountymi.org/1574/Opioid-Settlement-Funds
- https://ncdoj.gov/attorney-general-josh-stein-announces-26-billion-agreement-with-opioid-distributors-manufacturer/
- https://www.congress.gov/bill/115th-congress/house-bill/6
- https://nationalopioidsettlement.com/executive-summary/
- https://www.justice.gov/archives/opa/pr/justice-department-issues-guidance-protections-people-opioid-use-disorder-under-americans
- https://journalofethics.ama-assn.org/article/how-should-physician-respond-patients-pain-when-new-opioid-prescribing-laws-limit-shared-decision/2019-10
- https://micounties.org/opioid-settlement-resource-center/
- https://www.jnj.com/media-center/press-releases/johnson-johnson-statement-on-nationwide-opioid-settlement-agreement-
- https://www.michigan.gov/opioids/nel/laws
- https://nationalopioidsettlement.com
- https://ag.ny.gov/press-release/2022/attorney-general-james-secures-585-million-top-opioid-manufacturer-mallinckrodt
- https://www.ashp.org/drug-shortages/shortage-resources/injectable-opioid-shortages-faq
- https://www.in.gov/attorneygeneral/about-the-office/complex-litigation/opioid-settlement/
- https://oag.ca.gov/fentanyl/opioidslitigation
Answer from Perplexity: pplx.ai/share
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