I'm always dubious when the government gets into the business of mandating "education". I worry that the mandate will go through before any careful thought about what should be taught and who is qualified to teach it.
What I read in this article:
Administration Wants Tighter Painkiller Rules
By BARRY MEIER and ABBY GOODNOUGH
Published: April 19, 2011
http://www.nytimes.com/...
I got a lot more concerned.
Another article from USA today suggests everyone in politics who never treated pain themselves is jumping on the bandwagon:
http://www.usatoday.com/...
One doctors discussion forum shows mixed comments:
http://www.placebojournal.com/...
For better or worse, licensing doctors has always been a function of the states, not the federal government. Deciding what should be taught in medical schools has mostly been the business of the schools and the organizations that accredit them. Should the Federal government take over either of those functions? Perhaps. But a decision to do so should be carefully considered and openly debated; and if the decision is 'yes' the process should be carefully thought out and planned, with plenty of input from both doctors in practice and universally acknowledged experts.
Unfortunately, this looks like an attempt to take over part of both those functions by a bureau dominated by former narcotics agents, rushed through without proper consideration. The 'reasoning' in favor of it boils down to fear mongering about an alleged "epidemic" of prescription painkiller "abuse".
Apparently this is the brainchild of Obama's top drug policy adviser, R. Gil Kerlikowske. According to Wikipedia ( http://en.wikipedia.org/... ) he holds two degrees in criminal justice, he graduated from the FBI's National Executive Institute, and served as Police Commissioner or Chief of Police in four cities, including Seattle from 2001 to 2009. One amusing note on his career: he was drafted into the Army in 1970, and was stationed in Washington, D.C. where part of his responsibility was saluting then-President Richard Nixon as he boarded the presidential helicopter.
On paper at least, Mr. Kerlikowske seems well qualified to run a police program. But he seems grossly unqualified to decide if a partly medical problem should be handled by the police. Yet somebody in the Obama administration decided, if only by default, that police should be the ones in charge of federal policy toward treatment of pain with medicines. Did Mr. Kerlikowske make that decision? Was it left to him because the President didn't bother to listen to any other points of view?
The DEA isn't even the federal agency that has the most expertise in evaluating drugs. That would be the FDA. I would need to get whatever license the DEA cooks up to continue practicing medicine. So what would the required "education" be like? I have visions of sitting through some boring lectures given by a retired narc who thinks he can tell who's actually in pain and who is "faking it". The teacher may even think he can train me how to tell the difference in an afternoon, and then perhaps want to hold me legally responsible if I later prescribe oxycontin for someone he, with his superior knowledge, can tell was faking pain. That will grate, especially for a doctor board certified in Hospice and Palliative Medicine like I am. I graduated medical school in 1974, when we were still getting used to the word "hospice" in this country. I remember a superb lecture by Cecily Saunders -- but it was one guest lecture. The specialty of Hospice and Palliative Medicine only got organized in the 1990's, and the American Board of Medical Specialties recognized it as a subspecialty in 2006. The first certification exam under the ABMS was given in 2008. I studied hard for it, and passed. In the process, I learned a lot about pain. After all that, I don't want to sit through what I'm afraid will be a simplistic lecture by someone the DEA thinks should teach me about preventing drug abuse. I'll probably just be reminded of the drug abuse lecture I had to sit through in high school. As I recall, there was a movie that almost seemed to be an instructional film on how to shoot up heroin, and a pompous narc who kept talking down to us as, "You young people."
The American Academy of Hospice and Palliative Medicine should have been in on planning this program from the beginning. President Obama or Attorney General Eric Holder should tell Mr. Kerlikowske to cool his jets, start over, and come back with a program that can be endorsed by hospice doctors, represented by the AAHPM. Perhaps even more to the point, the American Board of Medical Specialties also has a subspecialty board of pain medicine. Pain medicine is a joint subspecialty of the boards of Anesthesiology, Physical Medicine and Rehabilitation, and Psychiatry and Neurology. In fact, that last specialty board, the American Board of Psychiatry and Neurology, also has subspecialties in Addiction Psychiatry and Psychosomatic Medicine. There is plenty of well organized medical expertise in the field of pain treatment and drug abuse. Did Mr. Kerlikowske even seek input from those specialty and subspecialty boards in planning this program?