Archive for November, 2007
Mangino Letter to Judge Motto, Brief in Support of Petitioner’s Motion, and, Supplement to Brief in Support; William Mangino, M.D.; War on Doctors/Pain Crisis blog of the Pain Relief Network; 2007-11-27. See also: Several days ago Dr. William Mangino whose case the Pain Relief Network has been involved with, and that this blog has followed in depth (see links above and below), sent me three documents, some fifteen pages in all, handwritten in block text, which I will call Mangino Petitioner’s Motion including:
Luckily, he also sent it to James Stacks, a board member of the Pain Relief Network, who is also in contact with Dr. Mangino. He has scanned it and made all three handwritten documents available, as a single PDF, through his personal website. Thank you so much, Dr. Stacks. Mangino’s letter to Judge Motto reviews William’s problems with his lawyers, his ability to represent himself, and his plight “of being convicted for a “crime” I never committed.” [In fact, there was no “crime” in this criminal case; see: Mangino Sentencing: a Crime-less Conviction by Christine Heberle.] In the Brief in Support of Petitioner’s Motion (scroll down), Mangino argues, in his cogent, thorough, and relentless way, “that [my] Sixth and Fourteenth Amendment rights to a fair and impartial jury were left unprotected by the court.” In this document William reviews the whole story of allegations of coercion of a juror named Fee by the jury foreman, and also recounts the Court’s denial of his Omnibus Motion for additional jury instructions, invoking Kansas v Narramore and “Rule 606(b),” in the process. The Supplement to the Brief in Support (scroll down) is also a fascinating and enlightening document. For example:
And so on. Wow. Dear readers, this is not legal babbling, this is serious legal thought. I am not educated in nor do I well grasp legal thought, but I think this will be a very interesting read for the likes of Drug Law Blog, Drug War Chronicle, and Drug WarRant. I am in the midst of a family tragedy at the moment and have not had time to help Mangino with this work, nor will I be able to attend the Hearing, which I think will be in New Castle, PA. I feel very, very bad about my inability to step up for Dr. Mangino at this time. I have reviewed Mangino’s medical records as an expert medical witness, I testified at his Sentencing Hearing. There. Was. No. Crime. Dr. Mangino is simply a very expert, smart, skilled and compassionate physician. His patients benefited from his care. The prosecution of Dr. William Mangino is a travesty. [See: Mangino I: Is Treating Pain a Crime?] I am deeply sorry that I cannot more concretely support him at this time; I surely would if I possibly could, and I hope my colleagues in the blog’o’sphere will take up the good doctor’s cause. The Persecution of Dr. William ManginoMangino I - Is Treating Pain a Crime? [END] As always, we ask that you help PRN fight to protect the rights of patients and the doctors who treat them. Thank you for clicking the link below.
www.painreliefnetwork.org The Persecution of Dr. William Mangino Originally Syndicated via RSS from War on Doctors / Pain Crisis
Sativex for Neuropathic Pain - Literature Review; Alexander DeLuca; War on Doctors/Pain Crisis blog of the Pain Relief Network; 2007-11-15. This essay refers to Sativex for neuropathic pain Pallimed blog1 has posted a review of very recent research on the medical use of cannabinoids, which are the medically useful, psychoactive, molecules derived from the marijuana plant including THC which is available in the U.S. in pill form as dronabinol (Marinol). Sativex, an “Oromucosal Spray,” is not available for prescription use in the U.S., and differs from Marinol because it is a whole extract of marijuana (cannabis), and therefore contains therapeutically active cannabidiols in addition to just THC. Sativex and Marinol are significantly different pharmaceutical products, with Sativex being pharmacologically more similar to smoked or vaporized dried cannabis bud, which naturally contain a mixture of THC and cannabidiols. Marinol is THC in sesame oil; period. Just to get the terminology and basic facts straight: cannabidiols are a family, if you will, of similar molecules with similar pharmacological properties that differ somewhat from those of THC, which is not a cannabidiol. Both cannabidiols and THC are cannabinoids. Sativa strains of cannabis have higher THC concentrations, while Indica strains are higher in cannabidiols, and are historically more valued as medicinals than are Sativa strains. Various Sativa/Indica hybrids exist and are produced, mostly, in indoor “grow-ops.” The very best article explaining the modern understanding of the endocannabinoid receptor system and its functions and peculiarities, in my opinion, is available from doctordeluca.com and is entitled: The Brain’s Own Marijuana. Very highly recommended to give you a firm neurological understanding upon which you can consider culturally charged issues like medical marijuana and end-of-life care. The graphics are spectacular. This Scientific American article is part of an actively maintained archive: Medical Marijuana, which is special collection #3 in The War on Pain Sufferers collections, to which I will be adding the recent articles reviewed by Pallimed, as soon as I can get around to it. Thank you to Drs. Rosiele, Sinclair and Quinn for your brief literature review of recent studies on the clinical utility of cannabinoids for the treatment of pain. Footnotes
Originally Syndicated via RSS from War on Doctors / Pain Crisis
Review of Critical Issues Related to the Treatment of Substance Abuse and of Chronic Pain; Alexander DeLuca; War on Doctors/Pain Crisis blog of the Pain Relief Network; 2007-11-15. Pain must be treated aggressively because it is harmful to the patient and to society. Pain must be treated aggressively because it is harmful to the patient and to society.
When specialists and academics and researchers come together to discuss common barriers to optimal pain management, they have found opioid therapy complicated, in both the pain medicine and addiction medicine fields, by misapprehensions and myths. Portenoy and Payne identified “Four types of phenomena that exemplify the accommodations that must be made to further [the goal of dissemination of accurate and up to date information to the fields].” 2 Briefly, excerpting from “Pain Specialists and Addiction Medicine Specialists Unite to Address Critical Issues.” 3
Footnotes:
Originally Syndicated via RSS from War on Doctors / Pain Crisis
The Purdue Plea Deal: Power Gets Its Way; by Siobhan Reynolds; War on Doctors/Pain Crisis blog of the Pain Relief Network; 2007-07-25. Purdue Pharma was coerced, under threat of destruction by the U.S. Department of Justice (DOJ), into pleading guilty to charges that their drug was “more addictive” than they had claimed, the government alleging that the company failed to inform both doctors and the public of this information when it came available. The problem for Americans in pain is that this private deal creates, if you will, a “fact” on the public record that is not factual, a “fact” that severely prejudices the interests of patients in pain. Whether Purdue is in reality guilty of misinforming the public as to the “abusablity” of the medicine is not in serious dispute. Indeed they seem to have promoted the drug as less abusable than other opioid medicines, even when they had evidence that recreational users had figured out how to defeat the time release mechanism. Opioid drugs are all abusable. Purdue’s attempt to stand out from other opioid pain medicines in this manner was certainly ill-advised. The lawlessness that we should be concerned about, however, is not Purdue’s but rather the United States Department of Justices’, whose character has changed much for the worse in recent years. One need only look at what happened to the Arthur Andersen corporation in 2005 to understand the overwhelming force exerted by the United States DOJ. When it seeks to get its way, the law be damned. See: While Arthur Andersen was ultimately exonerated by the Supreme Court, and more to the point, while the US DOJ was caught and exposed for procuring a criminal conviction without any showing of mens rea, Arthur Anderson was, nevertheless, destroyed as an institution. Purdue would have faced the same fate if they’d taken the government on. But in rolling over as they have, Purdue caved into the government’s desire to create facts through the application of power. The US DOJ has engaged in a brutal and systematic campaign to intimidate medical practitioners out of prescribing opioid medications, supposedly legal medications when prescribed by a licensed clinician. This has caused a society-wide breach of the duty of care owed patients by physicians and represents a wholesale attack on the doctor/patient relationship, severely impinging on the due process rights of Americans in pain. Many people in severe pain, especially those with high dose requirements, have been maimed or killed as a result. In coercing this plea deal, the US government effectively dissuades pharmaceutical companies from manufacturing better opioid pain drugs, drugs that are badly needed by the estimated [10 million Americans suffering in out-of-control pain][rsw99]. 2 As the US Government does not keep suicide statistics of deaths that result from untreated pain, the worst effects of the DOJ ’s policy and actions are not being reckoned with, either in the press, or in the Congress, or by the public at large. Nevertheless, patients, innocent ill Americans are dying in droves. In addition to suicide, they develop deadly conditions secondary to the stress of the barriers to relief they daily endure, often dying of conditions such as heart disease and stroke that arise as a result of the sedentary life style imposed on them by their easily treatable but untreated pain. Opioid medications have been a Godsend to man for over two thousand years, but now, in America under the Bush Administration, American men and women, even veterans and little children, are unable to access dosages that provide relief. The overarching goal of the government’s campaign appears to be the maintenance of the widespread and highly prejudicial (to patients in pain) confusion over the very real difference between the phenomenon of addiction and the phenomenon of physical dependence. While addiction is a terrible problem for that minority who suffer its ravages, it is indeed an affliction only rarely caused by exposure to opioid analgesics for pain. This was quite definitively demonstrated by studies done by the US Government itself on data compiled on soldiers returning from Vietnam. Physical dependence is merely a phenomenon that arises from ongoing use. Addiction is a poorly understood, far less common, disorder that appears to have environmental and genetic causes. Diabetics are dependent on insulin yet no one would assert that diabetics are addicted to insulin. Because of the Federal imperative to manifest a “drug free America,” which fuels the explosive growth of both Federal law enforcement apparatus and the addiction treatment industry, the simple, scientific truth that opioids are safe, and effective, and lack inherent ‘addictiveness’ poses a grave threat to the Federal bureaucracy. Hence the government’s ongoing attempt to confuse the population about the prevalence, natural history, and social cost of drug addiction. The Justice Department uses the Federal court system to coerce agreements out of people and companies so as to generate false evidence of a large drug addiction problem. The attorneys at the DOJ and the members of the Executive branch ultimately responsible for this effort are using their power to suppress science, undermining the public health. In doing so they act as domestic enemies of our Republic. We abhor this outrageous misuse of public trust, public moneys and goodwill, and denounce it in the strongest possible terms. – Siobhan Reynolds, Pain Relief Network References: [END]
Originally Syndicated via RSS from War on Doctors / Pain Crisis
Poems by Dr. William Hurwitz: Billy’s Lament, and, The Appeal; William Hurwitz, M.D.; War on Doctors/Pain Crisis blog of the Pain Relief Network; Written and originally published in 2005. Source: I like these poems. I’ve characterized the voice as Dr. Suess Meets Lenny Bruce, and I meant no disrespect. So, just because I like them, one more time…
Billy’s Lament I’m locked up in jail convicted of crime In spite of the stigma, in spite of the pain My friends all advised me “Let patients go” To keep them as patients was not to condone My judgment was flawed I must now confess Not only was I a soft, easy, mark
The Appeal I’m happy my case is being appealed My records were seized without probable cause The jury was left somewhat confused One of the rulings that prejudiced me National experts were all involved The document bolstered our position Embarrassed by what their experts had cast A charade it had been. That was now clear. [END] As always, we ask that you help PRN fight to protect the rights of patients and the doctors who treat them. Thank you for clicking the link below.
www.painreliefnetwork.org Originally Syndicated via RSS from War on Doctors / Pain Crisis
What are the FSMB Model Guidelines for State Medical Boards and the WHO Pain Treatment Guidelines?; Alexander DeLuca, M.D., MPH; War on Doctors/Pain Crisis blog of the Pain Relief Network; 2007-11-09. Prescription for Pain Care - AMAnews; 2004 AMA Position on Opioid Pain Management - revised 2007 Table of Contents: The FSMB Model Guidelines
The WHO Pain Treatment Guidelines In a paper entitled The WHO Analgesic Ladder for Cancer Pain Management, the authors performed systematic review (40 references) of MEDLINE and textbooks, direct contact of authors, and meeting proceedings, from 1982-1995, covering studies evaluating effectiveness of WHO analgesic ladder as an intervention for cancer pain management. They concluded that evidence provided was insufficient to estimate confidently the effectiveness of the WHO analgesic ladder for the management of cancer pain. Some direct quotations from this paper:4
Medical Guidelines are not Prosecutorial Tools Zech et. al. attempted to validate the WHO guidelines in a 10 year prospective study of some 2118 patients over a period of 140,000 treatment days. While the study supports wide dissemination of WHO guidelines to effect a clear improvement in the treatment of the many patients suffering from cancer pain in the clinical and home setting, the study does not support the contention, often made by law enforcement agencies, that the use of the guidelines pre-supposes preclusion of the initial use of opioids, in favor of nonsteroidal analgesics, or that the initial use of medications other than the opioids is either required or clinically desirable within the therapeutic framework of the management of malignant or non malignant pain.5 In this study 76% of patients (Table VI, page 68) were given and required opioids within 6 days admission. The number of patients eventually requiring strong opioids was 70% (page 70) and most patients required adjuvants (page 72) in addition to opioids.6 Footnotes
Originally Syndicated via RSS from War on Doctors / Pain Crisis
Join the forum discussion Dear Va: This is Pain Care?; Ian McLeod; War on Doctors/Pain Crisis blog of the Pain Relief Network; 2007-11-08. See also: I’m in an almost impossible situation. I live in a very small town in the middle of Oregon. I have been treated for chronic pain for the past eleven years or so by the VA in Portland, and was recently switched to a local clinic about 48 miles away. A med I used as a muscle relaxer and sleep med, carisoprodol, was summarily discontinued by a substitute clinician in the clinic who had never seen me before. He did a pill count, called me and told me I was abusing them, simply on the basis of the prescribed amounts, added that to the Drug Seeking Behavior file in my chart, and that was that. It was the only med aside from the herbal one I’ve been offered and refused due to the DEA’s stance on it that worked without debilitating and, in my situation, dangerous side effects. So now I sleep even less than usual, which was an hour or two at a time, or sometimes in a night. A few months ago, a new group of what I call “Narco-Nazis” arrived at the VA, and forced all pain patients to sign a draconian pain contract on threat of losing all care. Now, I am being forced to see this new “pain specialist”. He got his MD at OHSU, a degree in pharmacology, and work in “an interventional pain clinic” at OHSU for couple of years. He’s using a new standard from Washington, he says. It insists that 150mg equivalent to morphine is the maximum dose, and anything above that is a toxic level and carries a danger of respiratory depression. I am on 200 micrograms per hour of fentanyl, and WAS taking my former breakthrough meds as a regular dose, as the VA wouldn’t allow an increase in the patches. That was 10-15mg of Norco (10/325) and ½-1 15mg morphine IR PO Q4-6. Oh – the carisoprodol was 1 ½ (less does nothing) with that usually, and 1 ½-2 HS. Of course my pain levels when I get to the clinic are higher than usual, and they are higher than they should be anyway, but I’ve had to refuse neurontin (he says all the negative stuff I’ve read about it is wrong), SSRI’s because they make me very ill and short-tempered, baclofen, another dangerous meds I won’t take. So he’s decided I’m uncooperative. The VA has forced me, on threat of being cut off entirely, to see this so-called “pain management expert” (he isn’t) who is trying to force me to take meds I know don’t work or make me sick or that are far too dangerous. He’s an authoritarian, does not like being questioned (he got very angry when I asked for his credentials - I got ‘em anyhow, and he’s NOT qualified), plays dominance games, etc. He’s changing my regimen, in part to reduce the expense to the VA, to the detriment of my care! So far he’s canceled one pain med (without even notifying me) saying I can’t have both a short and long-acting one, removed the muscle relaxer that works and left me the one I loathe (diazepam), put me on too little of a med that doesn’t work well and makes me ill in a stacked dose (oxycodone), then at my insistence, changed me back over to the one he had canceled as the sole pill, but at too low a dose that he thinks is appropriate. He also intends to remove the patch it took a doctor almost a year to talk me into (turned out it worked better with fewer side-effects than anything ever has, but it’s expensive), and so on. I have no recourse within the VA system, because they have me down for “Drug Seeking Behavior”, meaning my condition requires opiates to control, and when they screw up I keep calling until it’s fixed. As I said, if it gets to where he’s aiming for, I’ll be barely able to move, and there is no other help here for my wife. If I can find a new doc, he has to take Medicare - it’s all I have - and I still have to find a way to pay for meds. Oh, he’s also referring me to the psych department (more trips I have to leave my wife alone for, try to beg a ride, get there very sore, and as always, all in the middle of my “night”), and an ophthalmologist four hours away, the latter for migraine-like visual effects. I TOLD him that’s the wrong specialty, but he won’t listen. He knows I have an unsafe vehicle I can’t do anything about, and that I have to leave my wife alone while I’m gone. He could care less. Not his problem. My 23 years with this condition, my own medical training and years in EMS and hospital work (Navy Hospital Corps, ICN and other such), the information I’ve collected over the years about pain management, all my MRI’s, CT scans, 6 back surgeries, psych test results from OHSU’s Neuropsych Dept. (I learned awhile back they had purged them from my VA record and replaced them; they may be gone again), the fact that I’m in an extraordinary circumstance as chief cook, bottle washer and everything else for an essentially bed-ridden wife, or that the trip to the VA plus the choice of hard chairs in the waiting room, then his forcing me to sit instead of lie down curled up when we meet adding to my pain – it all means nothing to him. He says my pain levels are up, so that justifies lowering my meds according his “standard” because my regimen isn’t working. If it goes much further I won’t be able to get to the clinic without an ambulance or a medical transport because of pain, and he’ll be able to throw me out of the VA system entirely for failure to show. The regimen I was on DID work – just not as well as before. Taking it all away and putting on medications that never helped before will only make things worse. I’ve spent decades learning what does and doesn’t help, and the meds I was on gave me back my life for a little while. I could move my equipment, play and sing a couple of nights a week, cook and do a little cleaning – until my wife got case #4 of pneumonia, and empyema and then the COPD. [END] As always, we ask that you help PRN fight to protect the rights of patients and the doctors who treat them. Thank you for clicking the link below.
www.painreliefnetwork.org Originally Syndicated via RSS from War on Doctors / Pain Crisis
Archived: “The DEA’s Regulation of Medicine” hearings, House Committee on the Judiciary, Subcommittee on Crime, Terrorism, and Homeland Security - 2007-07-12; Pain Relief Network Testimony and Related Documents; War on Docs/Pain Crisis ; 2007-11-08. Table of Contents
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