Moral Entrepreneurs Breed Righteous Indignation: The Case of DEA vs Tennant

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Religious buffs may recall that anger is considered sinful unless it is “righteous anger”. (Gospel of Matthew 21).  

We welcome Dr. Terri Lewis to teach us about Moral Entrepreneurs, Moral Indignation, and rapidly unfolding righteous anger among pain colleagues nationwide.

Here’s what Dr. Lewis has to say…

…what a society fears is essential to understanding its core values, and its highest aspirations. Philip Jenkins, Pennsylvania State University

Despite our history and the unprecedented contributions from science to healthcare the U.S. has begun to slip from its foundations of applied scientific practice that generates evidence for policy.  Many agree we are living in a moment of anti-science accompanied by profound distrust of scientific institutions as evidenced by the actions of public leadership.  This is engendering a system-wide moral anxiety derived from the utilization of techniques and tools associated with a social phenomenon that Goode and Ben-Yehudin (2009) have described as moral panic.  A moral panic is a feeling of fear spread among a large number of people that some evil threatens the well-being of society.  It develops when a condition or episode emerges to become defined as a threat to societal values and interests.  A Dictionary of Sociology (2014) defines a moral panic as “the process of arousing social concern over an issue – usually the work of moral entrepreneurs and the mass media (p.492).”  Within the field of public health, examples of moral panic include the belief that vaccines cause autism, access to abortion and birth control must be restricted, disease is spread through immigration, and that a war must be waged on the spread of drugs.

Moral panics have distinct and five identifiable features. First, there must be a concern or belief that the behavior of the group or activity deemed deviant is likely to have a negative effect on society. Second, the belief is associated with increasing hostility toward the group in question – they become “folk devils” with a clear division that forms between “them” and “us.” Third, there must be widespread acceptance that the group in question poses a very real threat to society. At this stage, the “moral entrepreneurs” are vocal and the “folk devils” appear to be weak and disorganized in part because of their characteristics. Fourth, the action that must be undertaken by society is entirely disproportionate to the actual threat posed by the accused group. Fifth, moral panics are highly volatile and tend to disappear as quickly as they appear, but they may wax and wane depending on the public interest or the agenda of those whose interests are served by maintaining the moral panic.

Those who initiate a panic when they fear a threat to prevailing social or cultural values are known by social researchers as moral entrepreneurs. Individuals, organizations, or institutions serving in this role –

  • Sound an alarm about an event they perceive to be morally threatening to society
  • Assert an agenda that selects social problems that they deem to be newsworthy applying finer filters to select candidates for moral panic and representative events.
  • Provide examples through assertions and rhetorical claims designed to create panics and proxies or scapegoats as representations for the moral panic; and,
  • Continuously makes and perpetuates the agenda, claims, images, and scapegoats

People who supposedly threaten the social order have been described asfolk devilswho –

  • Are associated with an event that has been identified by a moral entrepreneur as threatening to society
  • Act on an agenda that has been determined to be newsworthy or of concern to maintenance of the social order
  • Whose activities generate examples that support assertions and rhetorical claims
  • Who become proxies for the agenda of moral entrepreneurism, through claims, images and scapegoating.

Scapegoating is a method designed to create a proxy for moral contagion. Scapegoats are necessary to deflect attention and scrutiny from other forms of social intervention and action.  A “moral panic” is the best way to do that because scapegoating of a person or group of persons creates concerns and consensus about the characteristics associated with deviance, hostility that divides them from us, acceptance that the perceived threat associated with the scapegoat is real, and requires a disproportional response that consumes attention and resources. Scapegoats are contained within the cloak of stigma and practices designed to marginalize them, reducing their access to public resources and supports.  Persons with substance use disorders and persons with complex illnesses occupy the position of scapegoat in the public conversation about the harms or benefits of opiates.

Moral indignation arises from the dissemination of moral panic and the spread of moral contagion.  Moral indignation gains power by simply reporting and repeating anti-scientific and alternative ‘facts’ designed to generate concern, anxiety, or panic.  Parties to the dissemination of indignation include the media, politicians, and other stakeholders or institutions with a personal interest that will gain (attention, benefits, power) from the outcomes of crusading and muckraking. Moral indignation supports moral panic when the public, political systems or other institutions align together to create a dramatic atmosphere that –

  • Breaks the silence and embraces the voices of moral entrepreneurs
  • Sets the agenda by selecting deviant or socially problematic events deemed as newsworthy, applying finer filters to selected targets upon which to exercise moral panic and representative events
  • Transmits the images – transmitting assertions and claims by using the rhetoric of moral panics and reinforcing the selected scapegoats for the moral panic; and,
  • Continuously makes and perpetuates the agenda, claims, images, and scapegoats

It is within this atmosphere of anti-science that the war on drugs has morphed, creating a moral panic manipulated by moral entrepreneurs to distract the public imagination and scapegoat the very persons that would otherwise be protected – those with addiction and those who are sick, injured and require palliation.  This particular form of moral panic is doing more damage than good because it has set in motion the structuralization of an unscientific, socially constructed belief system that denies science, has assets and resources allocated to it, and occupies space in the physical world, digital spaces, and legal code books. Examples of this are the appointment of the White House President’s Commission on Combating Drug Addiction and the Opioid Crisis, the passage of state legislation designed to control and track the dispensing of schedule II narcotics, and the implementation of a nationwide PDMP system designed to track sales while using the same data to infer potentially wrongful utilization by the very nature of sales made.

The myth that prescription opiates are bad is built on the notion of fear, panic, contagion, and spread.  We are continuously subjected to a barrage of messaging which uses terms like ‘heroin pills’ or ‘I was hooked after 1 pill.’ As an ideology, it perpetuates the notion that physicians are naïve or predatory, that society must be protected from those who have substance use disorders, that patients are avaricious and dishonest because of their need for medications to palliate their symptoms of pain.  This culture of implied harms and fear is continuously used to disempower, exclude, and depoliticize those who are the most affected – consumers, their families, and the physicians who treat them. Authoritative figures who operate as moral entrepreneurs believe that protecting the public from this moral panic of opiate contagion is beneficial to protecting them from imagined catastrophe, along with their innocence and naivete. Moral entrepreneurs continually abuse their accrued power by perpetuating the message that they (individuals, organizations, institutions) know what is best for the public good whether or not the evidence exists to support their messaging.  In actuality, patients and physicians are losing access to their self-agency and scientific voice because of it.

(L to R) Keynote speakers: Kevin L. Zacharoff, MD, Michael E. Schatman, PhD, and Stephen J. Ziegler, PhD, JD, congratulate Fores (L to R) Keynote speakers: Kevin L. Zacharoff, MD, Michael E. Schatman, PhD, and Stephen J. Ziegler, PhD, JD, congratulate Forest Tennant after he received the PainWeek 2017 Lifetime Achievement Award.

Within this climate, the Drug Enforcement Administration (DEA), acting like a moral entrepreneur, has adopted a public stance that renews and heightens moral panic through public pronouncements that lump all opiates into an illicit bucket of social harms that only they have the moral authority to address.  Without the support of scientific principles or considerations of effective practice within the scope of either addiction or pain medicine, the DOJ has accelerated a moral panic that conflates the use of opiates by persons who are dependent or addicted or who are sick and injured, with anti-social behavior associated with illicit utilization that simply must be stopped for the social good. Overdoses have been adopted as a representation for contagion and spread, even as prescriptions have become a proxy for causing the deaths and poisonings associated with illicit drugs that flow to America’s streets despite the best efforts of the DEA and other policing systems.  The sale of medications serves as a proxy for spread of contagion.  Legitimate physicians are scapegoats for the distribution of illicit drugs. While there is evidence that this conflation is accelerating and increasing harms to the public good, the media has become a willing partner to perpetuating the anti-scientific notion that physicians who treat their patients with opiates are engaged in behavior which lies outside the realm of the social good. The continued failure of moral entrepreneurs to fail to distinguish legitimate process from illegitimate process serves an agenda that feeds both moral panic and public anxiety and should cause us to question the gains they derive from doing so.

It is within this climate of moral panic, that Dr. Forest Tennant, MD, DPH, addictionologist, public health expert, and an expert on intractable pain, was targeted last week by a raid on his clinic and his home.  Two independent pharmacy organizations that provide his patients with pharmacologic supports were also raided.  He is not the first, nor is he likely to be the last physician so targeted.  But unlike others, this servant-physician is among the most impactful on professional pain care because he serves the most complex and disenfranchised of patients who require knowledge and skills accrued through a lifetime of practice that are rarely found in communities.  Asserting that a physician who had dedicated his career to the study of addiction and pain is responsible for the epidemic of overdoses along with “Big Pharma” is absurd on its face.

Dr. Tennant has a community of careers that relies on and supports his lifetime body of work for persons with intractable pain and or addiction.  Much of what we have learned to distinguish the various models of care for all types of pain is derived from his 50 years of experience.  We collaborate with this physician through our professional research and educational activities to serve our most complex patients, and have gained confidence in his advising because we see the reduction of harms and increase in benefits to the consumers we serve together.  We are better clinicians because of his contributions to the field.

We find the actions of the DEA to be harmful to the care of our sickest community-located citizens and harmful to the physicians who serve this population across the nation.  We decry the labeling of persons with intractable pain as potential redistributors (folk devils) of the medications that keep them functioning within their families.  By these actions, the structural barriers that must be removed to serve persons with substance abuse disorders, complex illnesses, and pain in all of its forms are once again reinforced as proxies for maintaining contagion and moral panic even as harm the capacity of our health care system as a whole.

Please feel free to comment!


Dr. Terri Lewis
has extensive experience in the development and administration of community programs and systems of care for persons with disabilities and chronic health impairments. She has broad community rehabilitation industry experience, having collaborated extensively with local, state, and federal agencies to create community mental health and rehabilitation services for unserved and underserved persons with a wide variety of needs.  At this time, she serves on the academic faculty for two universities.  She collaborates with vocational programs in the USA and southeast Asia on the design of community based rehabilitation with special emphasis on Allied Health care coordination and personnel training.

 

 

 

References

Department of Justice (November 13, 2017) Application for Search Warrant Central District of California

Goode, E. and Ben-Yehuda, N. (2009) Deviance, Morality, and Criminal Law, in Moral Panics: The Social Construction of Deviance, Second Edition, Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444307924.ch6

Scott, John, ed. (2014), M: Moral panic. In, A dictionary of sociology, Oxford New York: Oxford University Press, p. 492, ISBN 9780199683581

Otto, S.L. (2012, Nov. 12). Antiscience beliefs jeopardize U.S. Democracy Scientific American, https://www.scientificamerican.com/article/antiscience-beliefs-jeopardize-us-democracy/

 

34 thoughts on “Moral Entrepreneurs Breed Righteous Indignation: The Case of DEA vs Tennant

  1. I was a patient of Dr. Tennant until The DEA bust now I am suffering extreme anxiety not knowing what will happen to me. I’ve been on a very high dose and am scared to death about tapering. Is tapering even safe for a 68 year old that has been on this high dose for almost 8 years?

  2. You are right, the problem is that those doctors and moral entreprenuers fail to realize that for those with intractable pain QUALITY of life trumps Quanity of life.

  3. This just keeps getting worse and in all honesty it is forcing regular every day citizens whio have chronic pain to just end it all them self, or go on the street and get medication they could be getting from a doctor or were getting untill the hysteria hit. Now you have insurance providers saying after sugiries we will only cover up to 7 days of pain medication. why dont we let the doctors do the job they went to school for and let the patient get the relief they need.

    That i guess would be to simple, so now the DEA and the insurance companies get to decided if you as a good intentioned doctor go to jail and the insurance companies get to tell the patient sorry 7 days is all you get.

    I have dealt with the stigma of being an addict my whole adult life because of all the surgiries i had when i was 14-18. trying to find a doctor to perscribe anything took years, but after my 78 year old father who was injured of the job as a police officer gets denied some simple relief for two torn rotator cuffs and just had his neck fused. This has gotten out of control and more people need to speak up and actually be educated on chronic pain conditions, and how these drugs help millions of people evvery day.

  4. For a bounded, metaphysically veiled, and destined society, enemies are necessary, conflict inevitable, and war likely. … If a state has no enemies it has no boundaries. To keep its definitions clear a state must stimulate danger to itself. Under the constant danger of war the people of a state are far more attentive and obedient to the finite structures of their society. …

    … War presents itself as necessary for self-protection, when in fact it is necessary for self-identification. Winning a war can be as destructive as losing one, for if boundaries lose their clarity, as they do in a decisive victory, the state loses its identity. …

    … What will undo any boundary is the awareness that it is our vision, and not what we are viewing, that is limited. … Poets who have no metaphysics, and therefore no political line, make war impossible because they have the irresistible ability to show the guardians that what seems necessary is only possible. …

    … Occurring before a world, theatrically, a finite game occurs within time. … The outcome of a finite game is the past waiting to happen. Whoever plays toward a certain outcome desires an particular past. By competing for a future prize, finite players compete for a prized past. … A prediction is but an explanation in advance. …

    … There is an irony in our silencing of the gods. By presuming to speak for the unspeakable, by hearing our own voice as the voice of nature, we have had to step outside the circle of nature. … Here lies the irony: By way of this perfectly reasonable claim the gods have stolen back into our struggle with nature. By depriving the gods of their own voices, the gods have taken ours. It is we who speak as supernatural intelligences and powers, masters of the forces of nature. …

    … This irony passes unnoticed only so long as we continue to veil ourselves against what we can otherwise plainly see: nature allows no master over itself. … What we thought we read in nature we discover we have read into nature. “We have to remember that what we observe is not nature in itself but nature exposed to our method of questioning” (Heisenberg). …

    … Explanations succeed only by convincing resistant hearers of their error. … Whoever wins this struggle is privileged with the claim to true knowledge. … Knowledge is like property. It must be published, declared, or in some other way so displayed that others cannot but take account of it. It must stand in their way. It must be emblematic, pointing backward at its possessor’s competitive skill. …

    … If explanation, to be successful, must be oblivious to the silence of nature, it must also in its success impose silence upon its listeners. … What one wins in a title is the privilege of magisterial speech. … The silence to which losers pledge themselves is a silence of obedience. … The victorious do not speak with the defeated; they speak for the defeated. …

    … One is speechless before a god, or silent before a winner, because it no longer matters to others what one has to say. To lose a contest is to become obedient; to become obedient is to lose one’s listeners. The silence of obedience is an unheard silence. It is the silence of death. For this reason the demand for obedience is inherently evil.

    James P Carse, Finite and Infinite Games

  5. I am a patient of Dr Tennant. Without him I would be dead. It’s a simple as that. He was the seventh pain doctor that I went to. Seven! He was the first one who listened to me. He was the first one who didn’t threaten me. He was the first one willing to talk to me. He was the first one who understood how my complex set of diseases work together to cause violent pain every second of every day over every inch of my body. I am a God fearing Christian woman and would never usually wish harm on anyone but if these government stuges could spend one hour in my body they’d QUICKLY change their tune!! Since starting high dose opioid therapy with Dr Tennant, I have my life back. My husband and I have a wonderful marriage. I can help my family. I can dedicate myself to my passion again which is charity work. I wish I could stand in front of congress, the senate, anyone who would have me and show them what they’re doing. Show them the face of someone who lives with this every day. God forbid they or their loved ones ever end up like me.

  6. Dr. Lewis, Thank you for sharing a sociological perspective of the “Opiate Crisis” rhetoric. I found your article so informative, and quite fascinating! I was unfamiliar with many of the concepts you presented and I appreciate your well-articulated explanation of the terms you use to describe the “moral panic” created by our current federal government and its policy makers, and echoed by many in the media.

    As a “folk devil” who has received compassionate and effective medical care that includes opiate medications for pain management, I deeply appreciate your thoughtful advocacy of people like me, many of whom are incapable of effective self-advocacy given our nation’s “moral panic” concerning opiate therapy. Thank you for supporting our community of pain patients, and for supporting Dr. Tennant. Your courageous example will, I hope, inspire your colleagues!

    I applaud you, Dr. Lewis, for presenting so eloquently your perspective, and for your well-articulated ideas and advocacy concerning physicians, healthcare professionals, academicians, and we plain ol’ pain patients who benefit so greatly from your wisdom, knowledge and courage to speak out.

    1. Thank you for your very kind words. This is so hard to articulate. But if we don’t find a way to get to common ground we will never make progress in this national conversation. That’s my goal – progress.

  7. I certainly hope that publications such as this are shared with members of congress, preferably Democratic, and other gov reps. Something seriously needs to be done before too many chronic pain patients overdose looking to street drugs being cut off from their opiate meds. This includes cancer patients, veterans, the elderly and even parents looking for anything to ease the severe pain of their sick children and elderly parents tortured with pain. There are millions in severe chronic pain suffering daily and the numbers are growing. With many turning to the streets, most of them inexperienced and bound to overdose easily, the illicit drug epidemic will RAPIDLY grow to astronomical numbers! Please start saring articles like these with your congressmen and gov reps!

  8. My husband takes 12 pills a day, prescribed on a 90 day refill schedule. If I put his prescriptions into this model, the physicians prescribe 1080 pills in one day, for that one patient.

    He does not take 1080 pills per day, but he is prescribed 1080 pills at a time! Let’s see, if I were to include the three refills for each, to get him through the year, that’s 4320 pills the doctors prescribe at a time!

    How far do you want to conflate a doctor’s medical proscribing care, before we (anonymous, pedantic public) understand any details and specifics!?!?!?

    I would like to VEHEMENTLY INTERJECT, that from this DISTANT, DETACHED POINT OF VIEW, and by THESE FACTS ALONE, we can DETERMINE …. ABSOLUTELY NOTHING!

    And while I understand that ADDICTION & INADVERTANT, UNINTENDED DEATHS are APPOINTED TO BE OUR CURRENT & PRESENT (dramatic) COLLECTIVE FOCUS of the moment…… PAIN & PAIN MANAGEMENT are, while not the SPECIFIC DRAMATIC FOCUS OF THE MOMENT, are also SERIOUS, LIFE THREATENING, QUALITY OF LIFE THREATENING CONDITIONS ALSO!

    I’d like to see these issues addressed OUTSIDE of the Public, by PROFESSIONAL, COMPASSIONATE, REASONED, CRITICAL-THINKING, CONTEMPLATIVE, BALANCED, TEMPERED, more JURISPRUDENT, MEDICAL MINDS than we more uninformed & unspecific voyeurs.

  9. Clearly, something is wrong with/at the DEA. Again, if law enforcement knows that a patient is diverting, call or email the doctor, simple as that. The good doctor will act on it…Isn’t that simple? As far as doses, in Georgia the medical board states that there is no magic recipe regarding the dosing of pain medications. If a patient is not diverting and is stable on their dosages of medications and the doctor is documenting compliance and functionality….what else can he/she do? Let’s help those who suffer and deal with those who abuse that precious act.

  10. Thank you Terri for this very insightful article that is dead on accurate – I found myself continually going back to the 5th Identifiable Feature of a Moral Panic and honed in on something that I believe is critical to this particular “War on Drugs” (Opioids in this particular decade’s war) – and that is the underlying agenda… There always is one.

    “Fifth, moral panics are highly volatile and tend to disappear as quickly as they appear, but they may wax and wane depending on the public interest or the agenda of those whose interests are served by maintaining the moral panic.”

    How I wish the first part of this statement would come to fruition and “disappear quickly” as we know the latter is very true… that those in current positions of power interest’s (agenda) are being served, and well, by perpetuating and maintaining this moral panic.

    Dating back to when many in the same group got together in 2006 to fund the NASPER Act and push the PDMP’s for what they started calling the Prescription Opioid Epidemic over 11 years ago. They found their sympathetic platform and have now funded the right people & resources to create such a mass “moral” panic utilizing many including the media, with the continuing misclassification of data and pseudo-science from the CDC to make it all so believable.

    #DROPTHETENNANTCASE
    AND THE PERSECUTION OF THE SICK, DISABLED & OUR VETERANS!

  11. This man has saved countless lives WITH and without opioid medications! DEA needs to follow honest to goodness science based pain medicine, and NOT PROPaganda!! Enough of the war on the most vulnerable patients out there and their providers!

  12. The substance of the allegations against Dr Tennant, are that his charitable activities cost money and he accepted money from a small Pharma company to support those activities. The small Pharma firm in question is INSYS Therapeutics, who make exactly 2 drugs.

    What’s not being discussed by DEA but should be, is that the second of the two drugs is Dronabinol, a cannabis derivative that became FDA approved in July 2017 to treat AIDS-related anorexia and cancer-related anorexia. DEA’s charges against INSYS relate to the first of the two drugs, an oral spray containing Fentanyl, that’s FDA approved to treat breakthrough pain in cancer.

    Dronabinol creates for DEA a conflict of interest. In a civil lawsuit brought by cannabis activists in the US District Court at New York City, it is alleged that DEA violated constitutional rights of due process of law, by restricting Pharma companies from even studying whether substances in the cannabis plant have medical uses, and by ignoring scientific proof generated by scientists abroad, that the cannabis plant contains substances that are medically useful. Plaintiffs allege that the DEA created these policies because it’s authority to prohibit cannabis, hinges on maintaining the legal fiction that the plant is useless and too dangerous to test. The fact that DEA is investigating the very first Pharma company to perform such a study and obtain an FDA license for the cannabis-derived drug Dronabinol, would seem to support the New York plaintiffs’ allegations, that the agency is indeed hostile to any scientist who discovers the cannabis plant to contain useful substances or otherwise dares to question their legal fiction, that the plant is too dangerous to study.

    The charges DEA brought in this seeming counter-attack on INSYS, are that doctors used the Fentanyl oral spray off-label, to treat patients who had severe pain from diseases other than cancer. Since it is legal to prescribe the Fentanyl oral spray off-label, to treat pain from non-cancer diseases, that usage does not violate any laws. Some doctors, according to the indictment in the INSYS case, may have made false statements to insurance companies about the cause of the patients’ pain, to induce insurers to pay for the INSYS medication. If that allegation is true, it may constitute insurance fraud, a crime the FBI normally investigates, not the DEA. Also if that allegation is true, it is true of the individual doctors who falsely stated that a pain caused by Disease B, was caused by Disease A. The fact that some doctor may have done that, does not in itself show a conspiracy by the makers of the drug, to trick insurers into altering their payment policies.

    What ought to be morally disturbing is the issue raised by Kentucky Senator Rand Paul, MD, in Senate debate three months ago. Senator Paul pointed out that health insurance company profits have doubled, since the Affordable Care Act was passed, yet the health insurance companies making these exorbitant profits claim that they are losing money and are demanding federal bailouts. Are insurers doubling their profits by refusing to pay for necessary medicines? And are those same insurers covering up this deceptive practice, by reporting patients to DEA as “potential addicts”? Or might those insurance companies actually be truthful in claiming that they are losing money, and simply lying to stockholders about doubling their profits, so that stockholders don’t dump the stock?

    Whatever sort of dishonesty by insurance companies led them to begin attacking pain patients by falsely accusing patients of addiction, demands to be investigated, because it jeopardizes the health care of every insured person who pays money, either their own or their employers’ funds, to insurers who promise to provide care.

    1. Dear Mr. Schubring,

      I read your comments in response to Dr. Lewis’ article with great interest. I had no idea that the DEA’s raids on Dr. Tennant’s properties have such complex and malicious motives! I find it fascinating – and incredibly disturbing – (but not surprising) that Dr. Tennant’s alleged involvement with INSYS Therapeutics is among the reasons for the agency’s attempt to discredit the physician.

      With the plethora of evidence that supports medical benefits conferred upon people who have a wide variety of diseases and conditions, I find it both absurd and unfathomable that federal government policy continues to justify the scheduling of cannabis as Schedule I. And I share your sense of outrage that the DEA would invade a respected physician’s privacy in order to further its ability to prohibit Cannabis research regardless of the potential benefit to millions of American citizens and residents.

      As an individual who has intractable pain due to various chronic conditions, I’m a ‘folk devil’ with vested rhetoric. Thank you for sharing your knowledge of some of the more insidious facts of the government’s harassment of Dr. Tennant. Your insight is greatly appreciated!

    2. It’s since been revealed that INSYS gave 500,000 to fight against marijuana legalization before it was voted on in Arizona, this was just before their version was to be marketed. I found company disclosures to the SEC to be interesting as well. Dr, Tennant must be a marvelous doctor to his community, he has done nothing wrong.

  13. That agency is an absolute threat to democracy and the United States government is Not defending the constitution of the United States and that is a violation greater than any law that has been passed by Congress.

  14. Outrageous.
    And intended to be.
    Witness tampering in the Christensen case.
    No accudent.
    A public health crisis unfolding:
    Dr Tennant’s very sick patients will be without their lifesaving medications if he cannot practice or obtain the patients records. Many will die without his care.

    1. Dr. Ibsen, I read your comments and your resume. You most rightly are indignant at the government interventions as we all have been. However there are physicians who do not practice proper medicine. They may con their patients, yet we must review the whole picture and those individuals involved in the mis- management of the practice of medicine. We all have difficult patients yet try to do the best for them. I was dismayed to learn by research that the Dr. in question prescribed 1,000 “pills over 14 days. That would be 71 pills a day or on a 24 hour wake day 3/ hour per day, on a 16 hour day 4 1/2 pill each waking hour, for a 12 hour day, Now the question was, ‘is that too much?'” While practicing in the same hospital as this Dr. I had as, Chief of Staff as did others to restrict, in fact remove his hospital privileges. I wondered ho long it would take for the final loss of license. Never would I dream he would “lose five then two more patients” from what the prosecuting attorney described in his repetition of his history. Forget the other clips of conspiracy and jury tampering. We are all accountable for our actions…

      1. Ps: Dr Ibsen… Please note I am not referring to the good Dr.Tennant (who recently testified in a case) but the physician just convicted by the jury in Montana. Jlw.,M.D., JD.

        1. Dr. Watts; I agree that there are good and bad doctors, as there are pharmacists, nurses, dentists, and engineers. Sorting out the bad apples is difficult but must be attempted. I do want to interject that “number of pills” is inconsequential if potency and mg strength of each “pill” is not considered as part of the equation. I am not in favor for example of giving 4 x 10mg OxyContin if I can give 1 x 40mg Oxycontin or 1 x 20mg Oxymorphone ER, all of which are presumably equivalent. The first example is 12 tablets per day at 10mg each; the second is 3 tablets per day at 40mg each; and the third is 3 tablets per day at 20mg each. It is arguments like this, although perhaps well-intentioned, that add to the rhetoric.

          1. Dr. Fudin, if I may further elucidate upon the need for individual counsel regarding patients and dosage by reminding Dr. Watts that such comparisons are infinitely more complicated by the 15-fold variation in metabolism of opioids due to genetic variations and additional factors affecting drug metabolism, such as malabsorption. One-size-fits-all attitudes in policy preclude the possibility that there are exceptions; and there are always exceptions, just as there are exceptional cases. Let doctors practice medicine. And do not presume to know what is best for a patient in torturous pain.

      2. IF, we are all accountable for our actions as you say then there is no need for unlawful organizations like the DEA. As free adults being of sound mind and body, IF this were a free co u try as everyone likes to believe (I dont) why are we treated as children? Do your really believe the govt, which is caught time and time again importing drugs, ILLEGAL drugs into the country, gives a damn about anyone but themselves and aggregating more power i to its own hands?
        He problem is the only unlawful and untoward here is an i elected undemocratic bureaucratic gang of armed psuchopaths running rough-shod over we the people. We as Americans are done of helping fascism yet when it is in our midst and operating w/impunity we are silent. This entire govt from top to bottom, BOTH parties operates OUTSIDE OF THE SUPREME LAW OF THE LAND, THE CONSTITUTION OF THE UNITED STATES OF AMERICA. If anyone needs arresting its 535 members of Congress, every alphabet agency head, party officers, lobbyists , and top ranking military. Until that happens there is no use in speaking to Congress, or arguing guidelines w/in the parameters of a preset narrative w/another organization that is actually a corporation not the govt (CDC). We have abrogated rule of our land to a foreign power. 8 families actually who charge us to print out own $. What other reason do we have to borrow money Into circulation when 1-its unlawful per Constitution 2- unnecessary 3 why on earth would an entity/govt PAY A PRKVATE BANK TO PRINT ITS MONEY when it can and has done so for no cosr? Are you aware of who is in charge of this country? Would it be the borrower (govt) or the lender (Federal Reserve Bank) a private bank made up of 8 families 75% of which are not even Anerican. So in a sense, one could say that that not only are we occupied (our taxes are much higher than ancient tributes paid by defeated kingdoms). The war of terror, the medical tyranny, the fluorided water, gmo-preservative-toxin laden food, domination of a private corporate system of jurisprudence . When our country was founded in order to have a criminal charge against someone had to either 1- be injured or killed 2- have his property stolen or damaged It was a fairly simple simple system of Constitutional Common Law courts not these unlawful commercial courts, private corporate courts controlled by UCC not common law. Go to YouTube and look at how many times judges are caught saying the Constitution has no place I “their court rooms’. There are no fair trials for doctors or Katie re when the State is both judge and prosecuted work for the state , who is an entity you cannot confront by law face to face in court.
        If you think I I’ve gone off the rails and off topic you have missed my point. This case as well as every other is nothing short of kabuki theater in a Potemptkin Village.

        What IS a govt which operates OUTSIDE of the law, the ONLY parameter that legitimizes its existence (Constitution)? An unlawful criminal oligarchy masquerading as the govt of a free country.

        Opiates are a pretext. Whenever a state of or a national emergency can be declared it is simply an exercise in advancing the use of powers u lawfully. Hegelian dialectic. They elicit a response through propaganda (see Smith-Mundt Modernization Act of 2012) which removed all restrictions against using govt produced propaganda on the American people) from a problem they created, then arrive w/a “solution ‘ which was prepared to put in place before the problem was introduced (see Opium production under the Taliban vs NATO control) Afghanistan. TJEM ponder the possibility that the DEA was unaware of the pill-mill epidemic, it’s their job to monitor scheduled drugs, yet hillbillies in KY, and drug dealing organized crime in NY,& housewives in MD knew all. about it?!?. This scenario was played out long ago in their little think tanks on how to subjugate a population.
        a conspiracy theory? You can bet your last dollar it is.
        m

        1. http://www.criminalgovernment.com/docs/emer.html

          The court system the unelected bureaucratic law makers and enforcers called are taking Mr.Tenant to? http://www.criminalgovernment.com/docs/frgn_juris.html

          why must an attorney, to practice law in AMERICA, belong to an organization w/an absurd name like British Accreditation Registry?
          http://www.criminalgovernment.com/docs/frgn_juris.html

          https://anticorruptionsociety.com/2016/11/12/it-is-all-a-word-game/#more-11303

      3. Dr. Watts, you make no mention of HOW MANY PATIENTS this ‘high prescribing’ doctor prescribed to. Certainly this doctor was not prescribing this amount to ONE PATIENT. So it HAS to have been MULTIPLE patients the doctor prescribed to. Also, given that less Doctors are prescribing, there are millions of people in pain, many doctors are abandoning pain management…Im not at all surprised that a doctor was prescribing in these amounts. And we could move even further, are all the ‘pills’ prescription opioid analgesics? are you sure? if not, then again, we have some vague data that many people, indoctrinated with all the anti opioid propaganda, will simply not understand and think it’s ‘too much’…..precisely why they dont understand and why they arent the patient or the one prescribing.

      4. Dr. Watts,
        Counting pills alone is part of the problem. Also not accounting for the different needs of each patient pertinent to their condition (which only the doctor/patient model is generally privy to). I have 5 intractable pain-causing conditions, each of which causes pain registering between 45 & 49 on the McGill Pain Scale – a scale that ends at 50. That pain level is higher than terminal cancer pain without the finality of death. Now multiply that pain level by 5. Due to the above-stated pain conditions of mine, and counting only the pills I take, my count IS 68 pills per 24 hours. Do you know what that count allows me to do? Live a life outside of the bed confinement I had before high-dose opioid treatment. I have a better, more medically stable health picture than I ever had before the pain was brought under control with this treatment. The pain is always present but is now MANAGED which, after all, is the goal of “pain-MANAGEMENT.” Activities of daily living are once again a part of my daily life and I am unaltered, lucid (as evidenced by my writing here), and under no symptom of addiction, even though medication dependence is inevitable in any long-term treatment of chronic illness. In short — I have a life once again only because of those 68 pills/per day. So can you see where you may be uninformed about this issue? I’m sure you now can. Stories like mine are why you see letters from patients saying, “Dr.___ saved my life” because for some of us, high-dose opioid treatment IS what saved, and continues daily to save – our lives.

        1. You are right, the problem is that those doctors and moral entreprenuers fail to realize that for those with intractable pain QUALITY of life trumps Quanity of life.

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