While we’re on the subject of doctors wrongfully prosecuted, let’s return to Dr. Peter Gleason, the Maryland psychiatrist accused of conspiracy for promoting off-label uses of Xyrem (narcolepsy medicine which [not to irritate the FDA here] may possibly potentially be of some use for depression and pain). Trick is, the FDA has only approved Xyrem for patients with narcolepsy. Dr. Gleason, after prescribing it and finding it helpful for many of his patients, was hired by Jazz Pharmaceuticals (the manufacturer), to give lectures on the subject to other physicians. In the course of his lectures, he mentioned these off-label uses – which the drug company itself is forbidden to mention or promote. So the charge is that the drug company paid him to advertise what they couldn’t say.

This is so completely bogus. The government spent months tracking this guy down – for doing what all doctors do every single day that they practice. Everyone prescribes medicines for reasons other than the government-approved indications. There are lots of anti-seizure medications which also work for chronic neurogenic pain, or mood control in bipolar or dysthymic patients. Some of them have now been approved by the FDA; but they were used for those purposes before the FDA gave its <hushed and reverential tone> seal of omnisicient, inerrant approval. That’s just the first example off the top of my head.

Has the FBI got nothing better to do with its time than prosecute doctors for actions which are completely condoned by their professional organizations? What on earth is the meaning of a Professional Board if not that it is supposed to oversee things like this? If the Maryland licensing board hasn’t got any complaints, then neither should the FBI. I was told that this is what is special about medicine, that we regulate ourselves, that we set higher standards than the law, and keep them ourselves. So if the FBI has set its standards so high that this doctor is a danger in their eyes, can we safely assume that crack and heroin dealers have been eradicated, that murder is nonexistent, that rape and kidnap are unheard of in Maryland, so now they have time to prosecute these minor infractions? (About this point I start having trouble keeping away from some recently learned vocabulary. Imagine a surgeon talking about this. . . )

This is of a piece with the government’s persecution of pain-management specialists – for instances of this pogrom, see the case of Dr. Rottschaefer, where drug addicts were promised clemency in exchange for perjured testimony, or the case of Dr. Hurwitz, who received a virtual life sentence after the government sent lying patients to swindle him out of narcotic prescriptions, or the case of Dr. Nucklos, where the prosecution withheld from the defense evidence of internal contradictions within the government’s case, or the case of Dr. Hassman, who was prosecuted essentially for not turning her patients in to law enforcement (violation of privacy, anyone?!), or the case of Dr. Herrera, who was picked as a scapegoat to lose his license “because of sloppy handwriting” after three young people from wealthy families who were not his patients died after oxycontin overdoses. . . Is that enough to be going on with? For more, check this AAPS News archive list of articles about such prosecutions, and this list of prosecuted doctors.

To return to the limited instance of Dr. Gleason: He was giving “continuing medical education” lectures. I once thought these would be completely bogus, since they’re funded by drug companies, with lunch by drug companies, and speaker paid by drug companies. Experience has shown, however, that they can be quite beneficial, since the speaker starts by reviewing the pathophysiology, epidemiology, and presentation of whatever illness is in question, before proceeding to show how perfect the drug being sponsored is for treating it. Personally, knowing who’s paying, I take the second half with a grain of salt, and learn some science from the first part. Moreover, there’s always one or two doctors present who will ask inconvenient questions like, what’s the absolute benefit ratio, what are the really bad side effects, and so on, and the rep will then have to answer frankly, so one gets some even coverage.

Anyhow, these lectures do have educational value, and thus the speaker honestly has to talk about off-label uses too. If everyone in the room knows that the drug can be used for X, and the speaker is a specialist in that area, it’s reasonable for him to talk about it. The times that I’ve heard this kind of presentation, the speaker acknowledges that it is off-label, and hedges himself pretty carefully by saying “in my experience – we don’t yet have thorough research for this – the mechanism is not understood – may not be appropriate for everyone” and so on, and we all know what’s going on.

I am sick and tired of government bureaucrats who don’t understand anything about medicine – or science, either, for that matter – trying to run doctors’ lives by a little rule book. If you want medicine by the rules, make a robot and have done with it. Doctors spend years in training in order to be able to know the exceptions that prove the rules. But now we have honest men who are trying to do their best by their patients and colleagues being prosecuted under the title of “the war on drugs.” It’s nice to know that the border has been sealed against drug smugglers, that the drug rings have been completely broken up, and there are no crack addicts dying in the streets, so that the government feels it has time to clean up the small things. The government has no sense of proportion, which is why it is the citizens’ responsibility to keep it carefully locked up to its constitutional responsibilities, waging war and running the postal service.

Please check out Dr. Gleason’s daughter’s website for further information and lots of phone numbers and email addresses, if you feel like expressing your frustration to some people in authority. Let’s speak up before the Gestapo comes for us too.