Doing the Right Thing, Even If You are Fearful
Phil Leveque, the Oregon doctor who unstintingly authorized cannabis use by patients in the early days following legalization -when almost all his colleagues were afraid to do so- has received a bill from the State Board of Medical Examiners to pay for his own prosecution. The bill is for $21,127.10. Leveque’s license was suspended for three months in 2002 because he hadn’t been conducting physicals (which were not explicitly required) or keeping patients’ charts (for security reasons) after mailing them to the office that administers Oregon’s card program. The Board created "the Leveque Rule," insisting on physical exams, and Leveque hired a physician’s assistant to conduct them when he resumed practice in a clinic setting where record-keeping was meticulous.
His license was suspended again in December 2004, and revoked earlier this year. After a lengthy investigation, the Board ruled that the exams conducted under Leveque’s supervision were too perfunctory, and that he had violated the "standard of care" in his treatment of six patients. None of the patients had complained about their care. According to attorney Ann Witte, who is handling Leveque’s appeal of the revocation, all the complaints against him came from doctors annoyed that he had enabled their patients to medicate with cannabis.
You’d think the appeal would stay the bill collectors, but no. "If you fail to send payment in full or make other arrangements, we may issue a lien on all of your property, both real and personal. We may then record the lien with your county and/or execute on the warrant. This means we can garnish your wages, your bank accounts, or seize your property to pay the debt in full." Leveque is 82, recently widowed, a World War II combat infantryman with a heroic record. Oregon thanks you, Dr. Leveque!
Leveque thinks that not the Board of Medical Examiners, which is dominated by MDs, is biased not just against marijuana but against osteopathy. (Leveque is a doctor of osteopathy with a PhD in pharmacology, which he spent many years teaching at the medical-school level.)
Osteopathic Manipulation Boosts the Endocannabinoid System
The June Journal of the American Ostopathic Association has an article by John McPartland of GW Pharmaceuticals and colleagues suggesting that osteopathic manipulative treatment (OMT) works via the endocannabinoid system. The researchers conducted a randomized, placebo-controlled study involving 31 subjects, and measured "cannabimimetic effects" with a neuropsychological questionnaire, and measured serum anandamide levels, before and after treatments. Subjects receiving OMT recorded cannabimimetic effects on the questionnaire, and serum anandamide levels increased 168% over pre-treatment levels. Subjects receiving sham manipulation record no changes in the questionnaire or serum anandamide levels.
McPartland et al noted that patients receiving OMT often experience an improved sense of well-being, sedation and euphoria -effects similar to cannabis consumption, and previous studies indicated these psychotropic effects are not elicited by endorphins.
A recent study by Andrea Giuffrida, who contributed to the OMT study, showed that "runner’s high" correlated with elevated anandamide and not endorphins, as commonly assumed. Patients receiving chiropractic, massage, acupuncture, and energy healing also experience parallel psychotropic effects. The endocannabinoid system may be mediating a widespread but heretofore unrecognized therapeutic phenomenon.
Scripture and Strategy
"He sprinkled the speech with biblical references, at one point using the tale of Esther to urge the jurors to do the right thing even if they were fearful."
-The Wall St. Journal, analyzing lawyer Mark Lanier’s successful techniques on behalf a Merck victim.
A few weeks before Lanier’s Bible-quoting was cited admiringly by the WSJ, Joe Talley, MD, had sent an email he called "Scripture and Strategy" to colleagues facing prosecution by the DEA. Talley is a North Carolina family practitioner whose willingness to prescribe opioids turned his office, over the years, into a clinic of last resort for thousands of pain patients. In 2002 Talley was raided by the DEA and had his license suspended. He faces criminal charges stemming from patients selling or overdosing on drugs that he prescribed.
Inspiring sermons are not commonplace today. But I did hear one this morning that might be (1) a little comfort to any prescriber currently beating himself up, and (2) more importantly, may have implications for future defense of some of us.
Even those of us who last saw the inside of the church as a 12-year-old, forcibly deposited, there will probably remember the parable of the wheat and the tares. The one where farmers woke up to find their wheatfield all grown up with weeds that some wise guy had sown. They asked the boss whether they should pull up the weeds, and he said, "No, you can’t tell the wheat from the tares at this point. If you go after the tares, you are bound to sacrifice a lot of good grain with it. So treat the wheat field with the same TLC you always did. The good grain is your priority. The tares we will deal with later."
For many people, that parable simply promises them that their enemies (all designated tares) will someday get theirs. (For a few, maybe it worries them that they might some day turn out to be tares themselves!) But the real point for today, the minister pointed out, was that all the trauma, bloodshed, discrimination, and other horror stories done in the name of religion today, everything from bloody religious wars down to squabbles about gays in the congregation, comes from Christians (Not to mention Muslims!) doing what the servants in the field wanted to do -go after the tares now. But that won’t work -we can’t tell who are tares and who are wheat- and it is not what our faith teaches us to do.
Some day I will be facing 12 men and women tried and true from the mountains of North Carolina (all there because they were too dumb to know how to get out of jury duty). They will live in little houses on the hillside, with American flags flying on their porch, and perhaps a sign saying "America! Love It or Leave It!" They will be haunted by the usual demons – communists, gays, liberals, foreigners, drugs (excepting alcohol and tobacco, of course), abortionists, and their rebellious teenage kids! They will almost all be professing Christians. They may not spend much of their time in a careful study of their faith, but they will remember, vaguely at least, the parable of the wheat and the tares.
At my trial, on direct exam I would want my attorney to say: "Dr. Talley, you admit you must have at some time or other given opioids to people who in fact didn’t need them, or at least that many of them, for pain relief. Why did you do that?"
I would answer, "Because there was no way to be sure. There was no accurate way to foil the drug abusers and dealers without denying mercy to people tortured by pain. All of us will remember the parable in Matthew, about the wheat and the tares. The government wants me to do what the Master’s servants wanted to do -to separate them out when there was no way to separate them out. To ignore the needs of the grain just to make sure the tares don’t get away with anything. There is no way to justify that scientifically or morally. Just as in the case of the wheat and tares, time will tell who is who, but there is no way to tell when the guy sitting across from me in my office appears to be suffering. There are things to do to try to narrow it down, and I did those things. But in the end, there is no way to be sure. And to deny 10 people mercy just to frustrate one drug abuser is just plain wrong."
In most of the trials I have followed so far, the jury has not had it hammered home to them convincingly that you cannot tell the wheat from the tares. The government has successfully advanced the scam that we really could have if we had just tried, rather than being criminally indifferent. When my turn comes, I think of trying in some way to put over Nancy’s sermon, "Why can’t we just pull up the tares?" in a fashion they can grasp.
Anyhow, now let us all bow for the benediction…