By Lynn Webster, MD, Guest Columnist
It is not uncommon for politicians, celebrities, and other ordinary people to hire a talented writer — who is called a “ghostwriter” — to compose a story or book. Ghostwriters are supposed to write in the author’s words, voice, and style, and they do not take credit for their authorship. In other words, they are the actual writers, but they are as invisible as ghosts.
This concept of a third party — in this case, a ghostwriter — standing in for the author is a collaboration that requires special talents and understanding of the author’s intent. The content that results from the partnership is not intended to be a vehicle to convey the third party’s views.
The ghostwriter’s job is to convince readers that they’re reading the words of the author. In other words, the ghostwriter has to pose as the author so that readers won’t know the difference between the voice of the ghostwriter and the voice of the credited author. It is a mutually rewarding relationship, and both parties agree to it.
There appears to be an analogous relationship developing in the area of pain medicine, but it is not a consensual relationship. Worst of all, nobody — least of all patients — benefits from it.
Determining patients’ medical problems and what the treatment should be for those problems customarily has been within a physician’s wheelhouse. However, lately, it seems as if the Centers for Disease Control and Prevention (CDC) and the Drug Enforcement Administration (DEA) want to sit in the physician’s chair and make decisions regarding treatment. In my opinion, they are usurping physicians’ decision-making responsibilities.
In other words, the CDC and the DEA want to be your ghost doctor.
Like a ghostwriter, a ghost doctor has certain abilities. But, these ghost doctors usually lack physicians’ training and expertise in pain medicine. Traditionally, most people would agree that most physicians have more information and knowledge to make medical decisions about their patients than the CDC or the DEA, but that perception appears to be shifting.
For example, in March of 2016, the CDC released its CDC Guideline for Prescribing Opioids for Chronic Pain. It blamed the opioid epidemic on doctors and condemned them for prescribing opioids for nearly any patient who hadn’t been diagnosed with cancer or a terminal illness. The CDC deemed itself better equipped than doctors to decide how patients with pain should be treated using opioids.
The DEA is the other regulatory agency that is interpreting what is, and what is not, a legitimate medical reason to prescribe an opioid. But they do not list these conditions. Physicians are left to guess what the DEA and their experts consider to be a legitimate medical purpose to prescribe an opioid.
This puts chronic pain sufferers in an impossible situation. Instead of receiving treatment from doctors who know them and care about their needs, patients are now at the mercy of ghost doctors — faceless regulatory agencies that have never met the people they are often condemning to pain, frustration, fear, and hopelessness due to actual doctors’ fear of sanctions if they do not comply with the government views.
A doctor’s first responsibility is to the patient.
But, due to pressures by law enforcement and the new CDC guidelines, doctors cannot fulfill this responsibility.
As Orlando, Florida’s WESH-TV reported, pharmacies in Florida were forced to deny medication to patients with legitimate prescriptions beginning in 2010 when the state decided it was necessary to address the opioid epidemic. Pharmacies blamed the DEA when patients couldn’t get the painkillers they needed, and the DEA blamed the pharmacies.
And, in the meantime, patients suffered.
Even Pam Bondi, Florida’s attorney general at the time, admits that the crackdown on painkillers went too far. But Jeff Walsh — DEA assistant special agent in charge of Central Florida — disagrees. “It’s tragic, but it’s an issue between the patient and the pharmacist, not the DEA,” he opines.
In other words, the DEA doesn’t understand how they have become a ghost doctor. I suspect neither does the CDC.
But the reality is that both the DEA and CDC are directly influencing physician decision making. Their words and voices are replacing those of physicians.
Perhaps that is not all bad. Regulation has its place in medicine. However, it isn’t all good, either. Guidelines and standards of care must be established by practitioners who understand the needs of their patients. There cannot be a formulaic approach to care, because one pain treatment will not work for all pain patients. That means ghost doctors can’t design treatment plans. Trained doctors must do that.
A ghostwriter may be able to manifest the voice of an author, but a ghost doctor can never replace the personal relationship and decision-making abilities of a personal physician. Ghost doctors can never successfully substitute for trained physicians.
Lynn R. Webster, MD, is past President of the American Academy of Pain Medicine, Vice President of scientific affairs at PRA Health Sciences, and the author of “The Painful Truth.”
This column is republished with permission from Dr. Webster’s blog.
The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.