Radley Balko fisks the DEA's Karen Tandy

May 16, 2005 8:07 AM

Radley Balko fisks the DEA's Karen Tandy 'So which is it? Are doctors a "very small part of the problem," or are they "the primary sources of diverted pharmaceuticals available on the illicit market?" ...I guess it depends on whether the agency is trumpeting its victories to Congress, or defending its tactics from critics in newspaper op-eds.'
posted by Kwantsar (34 comments total)

OMG. Damn those doctors, giving drugs to people!? Horrible.
posted by delmoi at 8:30 AM on May 16, 2005

Oh, come on, every cop and prosecutor knows that if you want a good arrest or conviction ratio, going after real criminals is a waste of time. Real criminals are hard to catch, and hard to keep because, well, they're criminals. And their assets are hidden or non-existent.

Far easier is to find a doctor with ties to the community with his assets tied up in seizable real property, take the assets (the government gets to keep the assets even if they don't convict) and scare the doctor into a plea bargain with the threat of multiple counts and the testimony of similarly scared patients.

"Crime"-fighting, like all other bureaucracies, is a business. Crime-fighters' careers depend on conviction ratios and net assets forfeitures. A program that becomes self-funding because of asset seizures is a plum any bureaucrat can make a fiefdom of, with promotion and post-retirement consulting jobs guaranteed.

As in any business, you need to know your niche markets, your highest profit-margin, lowest investment-cost sectors. For the DEA, that sector isn't hardened criminals operating on society's fringe. It's the rich doctors who thanks to licensing, the DEA already has the names of.

As in anything else, follow the money, and ask who benefits?
posted by orthogonality at 8:39 AM on May 16, 2005

Ah, the good old "war on drugs," eh? Nothin' better for business. After all, we have to protect the alcohol industry's turf, don't we? And everyone knows that drugs breed criminal behavior, not the other way around. 'Cause, like if it were the other way around, then prohibiting alcohol would have led to all sorts of illegal activity to procure and sell it, and we would have heard about it if that had happened.
posted by Mental Wimp at 9:41 AM on May 16, 2005

I can't believe we've managed to reinvent the witch hunt.
posted by cytherea at 10:44 AM on May 16, 2005

Also: 'fisks'?

You mean "refutes"? I sware these right wing bloggers think they are the first to do anything. And of course they have to come up with a word for it...
posted by delmoi at 12:04 PM on May 16, 2005

Also, this FPP could have been a comment in the last WOD thread.
posted by delmoi at 12:09 PM on May 16, 2005

Have a look at Tandy's fan club while you're here.
posted by telstar at 2:05 PM on May 16, 2005

Thanks Bob, great post.

DEA agent with gun pointed at doctor: "Stop prescribing pain killers for your patients with chronic pain or I'll shoot."

I wonder how many of these evil criminal mastermind doctors have been arrested at gunpoint? I'll bet most of them. Makes the DEA cops feel good to charge doctors with their guns out and pointed. And, heck, it's much, much safer then arresting real criminals, who might shoot at you, or resist arrest.
posted by joedharma at 3:45 PM on May 16, 2005

Piss on the DEA and the War on Drugs, full-stream, but this guy's just some Cato-employed hack, plugging away for an unfettered Big Pharma. Merck and Pfizer don't pay them for nothin'.

Even taken on its own merits, this article is bad. I don't have time to fisk his fisking, but the little wookie defense number he does about 128 pills a day not being so many is just plain dumb.

delmoi: to fisk.
posted by fleacircus at 6:55 PM on May 16, 2005

Even taken on its own merits, this article is bad

To the contrary, this article is clear, well reasoned and very well documented. The DEA's unwarranted and disproportionate focus and attack on pain management doctors is well documented and has been discussed for years. Balko has done an excellent job laying out the problem and its causes (the DEA).

This is a genuine problem. Many people with chronic pain in the United States don't get proper care and appropriate medication because of the DEA's intimidation of doctors.

The DEA's two sets of "facts," one that is trotted out for Congressional appropriations and a second that is used with the public, is set out and well documented in the article.

The reference to the 128 pills is one of the few weaknesses I saw in the article.

The suggestion the Balko is a stooge for the pharmaceutical industry seems goofy.

If the facts aren't right, I'd like to see it, but I don't think Balko is the one hacking.
posted by joedharma at 2:11 AM on May 17, 2005

this guy's just some Cato-employed hack

Well, that's a nice not-quite-ad-hominem...
posted by Kwantsar at 6:48 AM on May 17, 2005

I'm the author. Thanks for the nice comments. As for the criticisms, a few quick points:

1) I'm not a warblogger. I've been frequently and thoroughly criticial of the war in Iraq. I didn't vote for Bush (the second time). Check my archives.

2) My employer -- the Cato Institute -- gets no money from Pharma or from Purdue, the manufacturer of OxyContin (though frankly, I think they should give us some money). I'm not sure how this undermines my post. It's a rather juvenile, ad-hominem attack that also suffers from being baldly incorrect.

3) I also support the decriminalization of all drugs. In case you're wondering, Cato also doesn't get any money from Big Marijuana or Big Cocaine, either.

4) 75% of Cato's funding comes from private donations. Only about 10% comes from corporations (this is public information). The funny thing is, most corporations give most of their money to leftist causes, not conservative or libertarian causes. Yet it's still the limited-government advocates who get accused of ideological prostitution (frankly, I'd love it if they gave us more. If I'm going to get accused of being a whore, I might as well get paid). At any rate, the ideas and principles come first here. Then the money comes. I can think of several times where Cato has taken positions directly at odds with its corporate donors. Here are three:

Despite that we were founded with oil money (the Koch Foundation) and get money from othe oil companies, Cato opposed the Gulf War and the war with Iraq. Neither was a financially lucrative position for us to take. In fact, we lost donors as a result of our opposition to both wars.

Cato opposed FDA regulation of tobacco, even though a major donor (Philip Morris) supported it (PM wants FDA regulation because it will keep upstarts and competitors at bay, preserving market share for PM). Ironically enough, the American Cancer Soceity still cited PM's support of Cato as motivation for our position, even though PM explicitly and vocally took the opposing position. We also opposed the tobacco settlement, which every major tobacco company supported.

Cato has been very critical of Microsoft when the company has supported quasi-socialist positions on broadband and other telecom issues, despite that Microsoft has been a fairly generous supporter.

5) 128 pills per day is not outside the course of normal treatment for opioid-based pain therapy. There are thousands of patients who take upwards of 100 pills per day simply to function. Check some of the literature at the Pain Relief Network or other pain patient advocacy groups. It's important that people understand that these high doses are necessary to help people stop suffering, and not indicative of corruption or "bad" medical practice.

posted by rbalko at 7:11 AM on May 17, 2005

rbalko: 75% of Cato's funding comes from private donations. Only about 10% comes from corporations (this is public information).

Isn't this being a bit disingenuous? Just wondering about the affiliations and interests of those private donations.

There are thousands of patients who take upwards of 100 pills per day simply to function ... these high doses are necessary to help people stop suffering, and not indicative of corruption or "bad" medical practice.

Isn't the high quanta, a result of tolerance? Wouldn't the development of such tolerance be indicative of, at best, lax medical supervision?
posted by Gyan at 9:17 AM on May 17, 2005

On the former question, point taken, though again, donations come from people who like the work we do. We don't take donations with stipulations on what our position ought to be.

On the latter, the answers are yes and no, respectively. The high quantities are a result of tolerance early on, but after about six months of treatment the patient levels off (though the leveling occurs at a high dosage).

But tolerance isn't the result of lax medical care, it's expected, accepted, and dealt with as part of the course of treatment. Again, thousands of pain patients have attested to this method of treatment. The dosages may seem high, but they're necessary.

It's also important to note a clear distinction between "addiction" and "dependence." Patients at high dosages are dependent on pain meds to function normally. But they aren't "addicted." Addiction is a physical and psychological need for euphoria. These patients don't experience euphoria, they experience relief.

Put another way, addicts will ruin their lives in search of euphoria. Physically dependent pain patients need meds just to function normally -- or to keep their lives from being ruined.
posted by rbalko at 9:43 AM on May 17, 2005

rbalko: Put another way, addicts will ruin their lives in search of euphoria. Physically dependent pain patients need meds just to function normally -- or to keep their lives from being ruined.

Again, isn't this disingeneous? It's prohibition that relegates addiction from an inconvenience to a potentially life-ruining condition. Successful heroin prescription programs in Britain, Switzerland and Holland attest to that.
posted by Gyan at 10:08 AM on May 17, 2005

I don't think Balko would disagree with you, Gyan, and I don't know how that little technicality undermines his larger point.
posted by Kwantsar at 10:42 AM on May 17, 2005

Kwantsar: I don't know how that little technicality undermines his larger point

His larger point, presumably, is, "It's also important to note a clear distinction between "addiction" and "dependence."". I don't see how his point remains, in terms of opiates. There was a study I came across recently, that put forward that negative reinforcement was a major factor in opioid addiction.
posted by Gyan at 10:57 AM on May 17, 2005

I don't think his definitions of addiction and dependance are right (if anyone's still reading).

On the other hand, these people are in horrible pain, and would be even if they never took any opiates. So the fact that they build tollerance isn't really that important.

Also, when the pain stops they no longer need the drugs, so they are only "addicted" as long as there is pain.
posted by delmoi at 2:40 PM on May 17, 2005

Gyan's absolutely right, those stupid chronic pain sufferers need to suck it up and get a life. Jeez, what a bunch of whining drug addict losers. A lot of these chronic pain screw-ups think they deserve normal lives, they would like to hold down jobs and lead decent, functional lives. Thank God the DEA is there to stop them!!!!
posted by joedharma at 4:00 PM on May 17, 2005

Rbalko, thanks for the clarification and additional information, very interesting.
posted by joedharma at 4:05 PM on May 17, 2005

Strawman, anyone???
posted by Gyan at 4:47 PM on May 17, 2005

Strawman, anyone???

It sounds like you think you're in a debate class. Argumentum ad logicam anyone???

This is a real issue with real people whose lives and livelihoods are being intentionally destroyed by the government (and specifically the drug diversion cops at the DEA) as part of a bizarre moral crusade.

Balko seems spot-on. If you have something material and substantive to say to the contrary, say it. Otherwise, why not try to show some concern for the people who are getting screwed-over by the DEA?
posted by joedharma at 3:05 AM on May 18, 2005

I am never surprised to see some government agency go to extremes to solve a minor problem when given too much authority. Of course if you restrict their authority to prevent such abuse then they become even more bureaucratic and less efficient.

The best part of this whole post was finding The Agitator, Radley Balko's blog. Lot's of interesting stuff there.
posted by caddis at 6:48 AM on May 18, 2005

"lots"
Sheesh, where did that apostrophe come from? Lot doesn't have interesting stuff, he has a pillar of salt for a wife.
posted by caddis at 7:40 AM on May 18, 2005

joedharma: It sounds like you think you're in a debate class.

It sounds like you haven't taken an English comprehension class. Show me where I said or implied that pain patients must suffer or avoid medication via controlled substances.
posted by Gyan at 9:01 AM on May 18, 2005

Gyan, do you know of an alternative treatment? It sounds like you're simply protesting that they shouldn't take so many pills, regardless of pain or tolerance levels.
posted by cali at 10:42 AM on May 18, 2005

cali: No, I was simply under the impression that tolerance was avoidable, or significantly controllable, with a proper dosing regimen. Apparently not.
posted by Gyan at 11:47 AM on May 18, 2005

rbalko writes: "The funny thing is, most corporations give most of their money to leftist causes, not conservative or libertarian causes."

What the heck are you talking about?

Can you cite a single source that remotely suggests that corporations give "most of their money" to the left, rather than to the rightwingers?
posted by felix at 12:58 PM on May 20, 2005

What the heck are you talking about?

Those links neither prove nor disprove your point as they only measure donations to the party itself, not the variety of surrounding organizations from Cato to MoveOn to NatPAC, ad nauseum. Cato wouldn't be included in either of the links, so I think you're looking at the wrong dataset.

I don't have a better answer offhand, but you haven't disproved him.
posted by thedevildancedlightly at 8:18 PM on May 23, 2005

No, I was simply under the impression that tolerance was avoidable, or significantly controllable, with a proper dosing regimen. Apparently not.

That is a popular misconception. Here's a good article with more info on the subject written by someone who has lived with chronic pain for a long time.
posted by straight at 11:31 PM on May 24, 2005

straight, that article doesn't really cover tolerance. It is my understanding that some street opiate users overdose because they consume their usual tolerance-molded high dose after a gap of 5-6 days. In that period of absence, tolerance has dropped sufficiently enough that the "regular" dose becomes an overdose.
posted by Gyan at 9:21 PM on May 25, 2005

I'm noticing rbalko's response way too late. Thank you for the comments, you seem like a good guy.

2) My employer -- the Cato Institute -- gets no money from Pharma or from Purdue...

Cato gets no money from Eli Lilly, Merck, or Pfizer? Some web sites say otherwise. I suppose they could be wrong.

I never said you guys got paid by the word. Cato does seem very interested in defending the drug companies, so congratulations for being paid to do something you feel passionate about. That would make the drug companies natural allies, why shouldn't they give you support? I'm sure funding is not considered when Cato weighs policy or new hires. Not at a place that would have Rupert Murdoch on its board, no.

Sorry to impugn the motives of your pro-business anti-government think tank, dude. I know we're supposed to assume innocence with you guys.

3) ... Cato also doesn't get any money from Big Marijuana or Big Cocaine, either.

I guess not if you keeping saying things like "Teens are going to experiment. Better Vicodin than heroin." Anyway you're not proving anything: I imagine the American drug companies have more to gain from legalization than the current 'Big Marijuana' and 'Big Cocaine' concerns.

4) 75% of Cato's funding comes from private donations.

That alone proves little. Maybe if you could point us to a profile of the top donors and their interests, for the lazy. Any way to know how much money Cato gets from people and organizations with pharma ties? If it doesn't matter, there's no harm in telling honestly without minimizing it, right?

Some specific things about your article that I didn't like:

You take the quote "Doctors and pharmacists are the primary sources of diverted pharmaceuticals" and morph it a little to doctors being the (sole) primary part of the overall problem of oxycontin abuse. Like taking (as a totally made up example) "Central and South America are the primary sources of illict drugs" => "Central America is the primary problem in the war on drugs". You lost Asia, you lost distribution and sale and consumption. Sure, the DEA may be dissembling, you seem to be as well.

Your rearguard action on the 200 arrests was not very impressive. I'm already predispositioned to dislike the DEA but somehow I couldn't care. Your clincher is an anecdote: "I'd say on average [Dr. Fisher] sends two articles per week about new doctors being investigated, arrested, or tried for diversion." Well at 1 doctor per article, that's about 100 docs a year being investigated, arrested, or tried. I'm not sure how "terribly misleading" the 42 arrests/year looks up against the power of your anecdote.

You defend the 1600 pills claim, which did sound like some risible DEA grandstand, by saying it was both a clerical error and a perfectly rational dosage. Both prongs, but it seems like you tried to win the argument by shaking a bigger bag of pills with some iffy logic behind it. Nothin' wrong with a bag of a few thousand pills; it's convenient, and when you're done you can put fresh veggies into it -- and fresh veggies are very important for our chronic pain sufferers.

Later on you try to say that the DEA's claim that doctors are a primary source of the illicit drugs (the primary source) is at odds with the DEA's claim that only the rare doctor is diverting. Big logical fallacy. It made me stop reading and sigh.

I didn't think your article was very good, because your tone of DEA = evilalwayswrong, while being all "won't someone think of the suffering children?" didn't ring true to me. Frankly your article reminded me of a rebellious teenager who takes statements from teachers and students way too literally to show just how totally bogus and lame they are.

I have both doctors and chronic pain sufferers among my friends and family, and I'm pro-legalization. I probably agree that the DEA are a bunch of jerks who are unfair to doctors. I was already on your side. But somehow the tone of your article made me want to take the DEA's side, and made me doubt your claims as much as theirs. And then I saw you were from Cato and said "ah, a spinner."

Hence my earlier comment: mediocre article from a Cato/pharma footsoldier. Why bother?
posted by fleacircus at 12:44 PM on May 26, 2005

joedharma:
This is a genuine problem. Many people with chronic pain in the United States don't get proper care and appropriate medication because of the DEA's intimidation of doctors.

I know some of them. I'd like to see some credible information about this in a good general post. If you know a lot about the subject maybe you could craft a multi-link FPP about it -- instead of something like this single link FPP to the tail end of an argument presented without context.
posted by fleacircus at 1:50 PM on May 26, 2005

("lost Asia" above should be lost South America...)
posted by fleacircus at 1:52 PM on May 26, 2005