John Tierney on William Hurwitz

In his New York Times science column, John Tierney reviews the issues in the federal prosecution of Virginia pain doctor William Hurwitz for "drug trafficking." Although the government says Hurwitz must have known some of his patients were abusing and/or selling painkillers he prescribed for them, Tierney notes, research indicates that neither cops nor doctors are good at spotting fakers:

To researchers who study deceptive patients, there is no such thing as a blatant red flag. Deception is notoriously difficult to spot, as Dr. Beth F. Jung and Dr. Marcus M. Reidenberg of Cornell University document in a new survey of the literature. They note, for starters, an experiment showing that even police officers and judges—ostensibly experts at detecting fraud—do no better than chance at detecting lying.

Doctors are especially gullible because they have a truth bias: they are trained to treat patients by trusting what they say. Doctors are not good at detecting liars even when they have been warned, during experiments, that they will be visited at some point by an actor faking some condition (like back pain, arthritis or vascular headaches). In six studies reviewed by the Cornell researchers, doctors typically detected the bogus patient no more than 10 percent of the time, and the doctors were liable to mistakenly identify the real patients as fakes.

When treating people with chronic pain, doctors have to rely on what patients tell them because there is no proven way to diagnose or measure it.

Tierney also notes that the quantity of pills prescribed is not a reliable indicator of abuse:

There is no standard dosage of medicine: A prescription for opioids that would incapacitate or kill one patient might be barely enough to alleviate the pain of another.

During the first trial, the prosecution argued that it was beyond the "bounds of medicine" for Dr. Hurwitz to prescribe more than 195 milligrams of morphine per day, but dosages more than 60 times that level are considered acceptable in a medical textbook. The prosecution's supposedly expert testimony on dosage levels and proper pain treatment for drug addicts was called "factually wrong" and "without foundation in the medical literature" in a joint statement by Dr. Russell K. Portenoy and five other past presidents of the American Pain Society.

Portenoy is testifying for the defense in Hurwitz's second trial, which began yesterday.

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  • ||

    A case like this, my first instinct is to get pissed off that the bastards prosecuting will get away with it. Upon reflection, I'll just be relieved if an innocent man (and he's innocent even if everything they say about him is true) doesn't go (back) to prison.

  • ||

    Please explain how O.J. Simspon and Robert Blake walk, while this guy stands a chance of doing time. What is the percentage of non-idiotic juries?

  • ||

    What is Portenoy's complaint?

  • ||

    Portenoy's complaint is that "(t)he prosecution's supposedly expert testimony on dosage levels and proper pain treatment for drug addicts was ... 'factually wrong' and 'without foundation in the medical literature.'"

    That's what his complaint is.

  • ||

    de stijl, I really have to hand it to you for that remark. No really, I'm not jerking you around.

  • ||

  • Robert||

    So the best thing is for chronic pain patients to become "addicts" and get on methadone.

  • ||

    Please explain how O.J. Simspon and Robert Blake walk, while this guy stands a chance of doing time. What is the percentage of non-idiotic juries?

    Because OJ Simpson and Robert Blake were not accused of any activity that makes people happy. When you kill someone, you are really just send them to Jesus sooner... but when you give someone physical pleasure, you doom their eternal soul.

  • ||

    what if you are self-pleasuring to mental images of jesus second coming? thats the solution to portnoys complaint

  • Paul||

    To researchers who study deceptive patients, there is no such thing as a blatant red flag. Deception is notoriously difficult to spot,

    I'm not speaking to the particulars in the case of Hurwitz, but this depends highly on the setting and the circumstances.

    There are cases where it's hella easy to spot- especially because the "patient" is a horrific liar.

    Patient: "I need some [fill in highly powerful pain drug here] for some... uh, back pain."

    Provider: "Ok, we'll need to examine you before we right a prescr--"

    Patient: "No, I just need the meds."

    Provider: "Well, it doesn't work that way, we normally--"

    Patient: "Oh I get these all the time, I just ran out."

    Provider: "Ok, where were you getting them?"

    Patient: "The uhh, internet."

    Provider: [looking quizzically at nurse] "you uhh, should probably continue to get them from that source"

    Patient: "oh, that site isn't available anymore."

    Provider: "Well, we don't just write prescriptions for controlled pain medications without a full exam."

    Patient: "Look, my leg has been hurting really bad, why can't I just get the meds?"

    Provider: "I thought you said it was your back."

    Patient: "Yeah, I said that, my back."

    This exchange is far, far more common than you'd think.

  • Paul||

    previous provider comment should have read

    "...before we write a prescription"

    It's the meds, so I can be forgiven, right?

  • LarryA||

    So the best thing is for chronic pain patients to become "addicts" and get on methadone.

    Actually the best thing is to get caught with enough illegally-obtained pills to get convicted as a drug dealer, so they get sent to prison where they're issued a morphine drip and can quit screaming.

GET REASON MAGAZINE

Get Reason's print or digital edition before it’s posted online

  • Video Game Nation: How gaming is making America freer – and more fun.
  • Matt Welch: How the left turned against free speech.
  • Nothing Left to Cut? Congress can’t live within their means.
  • And much more.

SUBSCRIBE

advertisement