Drug Policy

John Tierney on William Hurwitz

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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.