So let’s take a look at Dr. Stuart Gitlow, for an example—an established, nationally renowned physician, author, professor, addiction specialist.  In his practice he has used multiple methods to treat addiction. As a conventionally trained physician, he looks at, and believes in the standard “evidence-based” method of hypothesis-trial and error protocols in determining the “professionally correct” explanation of a disease process.  Right now, the current theory driving addiction treatment is that it is a “brain disease”. I would welcome anyone that would research exactly where this hypothesis originated, and what “evidence” is being used to construct it. Dr. Gitlow is a believer in the current “brain abnormality” cause of addiction and therefore supports the conventional treatment with medications such as buprenorphine. This is standard of care now in the conventional medical field of addiction medicine.  When all you have is a hammer, everything is a nail.  But does that belief make you a criminal?

In medicine, when a new medicine becomes available, pharmaceutical representatives come knocking on your door. They explain the mechanism of action, and leave you some samples to try. I guess the next thing that the government will try to criminalize doctors, is to say that is a bribe. But really, doctors are working for the best interest of their patients (unless they are hospital-employed, but that’s another topic for another post. Anyway, the government isn’t interested in attacking them, but the independent physicians that DO work for the PATIENT). Now when a doctor uses a new drug and it works better than anything else used in the past, then that doctor will increase the use of the product, and more patients will be put on it. It is the doctor’s use of the product that then draws the drug manufacturer to approach that doctor to ask them to be a speaker, to spread the word about the drug to other physicians.  That is not a kickback. That is a recognition that the doctor thinks highly of the drug.  That is a standard part of a capitalist economy. If you believe in something, you sell it, push it, promote it, etc.  Why are doctors the only profession where this action becomes criminal?  Why aren’t all of the multi-level marketing companies (like Mary Kay, Amway, Melaleuca) being charged criminally for investing in a product that they then recommend to others? What’s wrong with this picture?  Doctors are simply easy targets.  It is BECAUSE their main interest is the health and well-being of their patients that this is being done.  The government knows that they are too busy with their practice to even put up a defense. And because of their goodwill and benevolent nature, they don’t see how the American people could charge them with a crime for doing what, in their mind, is best for their patient.

Now is it a crime to then invest in the product that you believe in?  Again, we are in a capitalist society. Is it a crime to make money?  If so, then why aren’t Trump and Bill Gates in prison cells?  Were they held accountable when they believed in a product, and then invested in a company to sell that product?  Have they defrauded the people they sold the product to?  Of course not! So then why are doctors being charged, or even accused of doing that?  Now let’s go back to Dr. Gitlow and look at this through clearer lenses.

In their Disclosure of Interests and Affiliations, the American Society of Addiction Medicine (ASAM), for which Dr. Gitlow was former president, defines “significant interest” as: Compensation which includes cash, shares, and/or anything else of value (including gifts, travel, lodging, meals, honorarium, goods and services) totaling $5,000 or more in value in a year;  Involves direct ownership of shares, stock, stock options or other interest of 5% or more of an entity or valued at $10,000 or more (excluding mutual funds), whichever is greater; Derives income or influence from a position as director, trustee, proprietor, officer, managing partner, consultant, or (full or part-time) employee.

On his Disclosure of Interests and Affiliations, Dr. Gitlow denied any significant interest in any business that does business with ASAM, competes with ASAM or derived from his service/status as an officer, trustee, director, proprietor, partner, employee, grant recipient, or consultant for any health care or health-related business or organization. As sources of income over 5%, he only listed his private practice and his Annenberg Physician Training Program, not any of his income from pharmaceutical companies. In the area of public representation and advocacy (including lobbying) on behalf of any organization other than ASAM, he only mentioned being an officer for Smart Approaches to Marijuana (SAM). Now the date of that disclosure is not listed. But since Dr. Gitlow was president of ASAM from 2013 to 2015, I would imagine the disclosure was submitted in 2013.

Now according to the Centers for Medicare and Medicaid Services, Dr. Gitlow received $43,444.98 from 2014 to 2016 for consulting with Kaleo, Inc, makers of the opioid overdose antidote Evzio (Naloxone HCl injection), Reckitt Benckiser, makers of Suboxone, and Orexo, makers of the opioid products Abstral (Fentanyl) and Zubsolv (Buprenorphine/naloxone).

However, on January 29, 2018, an article appeared on thefederalist.com entitled “Is There a Big Pharma Fox In The Anti-Addiction Hen House?”   Here, David Marcus jumps on the band wagon of accusing doctors and the organizations they belong to for being influenced by Big Pharma in determining the advice they give–in this case, the American Society of Addiction Medicine (ASAM). ASAM was founded in 1954 to study and improve the use of addictive substances in health care and has since become an important voice in legislative and regulatory initiatives pertaining to addiction.  Mr. Marcus points out that Dr. Gitlow, ASAM’s past president and Dr. Kelly Clark, the current president, have financial interests in companies selling addiction medications. Dr. Gitlow is medical director of Orexo, a manufacturer of buprenorphine, and Dr. Kelly Clark as the chief medical officer for Clean Slate, a company that partners with Apple Tree Partners, which owns a pharmaceutical company and has funded an advocacy campaign that supported buprenorphine treatment. In addition, Pharmaceutical companies contribute to ASAM. Indivior, a major producer of buprenorphine, is a member and funder of ASAM, contributing $100,000 a year.

Mr. Marcus also reports that, in advocacy for the use of medication-assisted treatment, Dr. Gitlow wrote a letter in 2014 to HHS Secretary Sylvia Burwell, recommending increasing the number of patients who should be given access to buprenorphine. He then also supported a decision by state Medicare programs to switch to the Orexo brand of buprenorphine products. But does that create a conflict of interest? And does it warrant federal criminal conduct treatment? Hardly. Bottom line—through his practice, Dr. Gitlow believes in medication-assisted treatment because it has helped his patients avoid street drugs, escalation of drug use, and ruination of their lives. He does what any capitalist would do—invest in what he sees working.  No harm-no foul. 

Doctors are simply easy targets for government attack.  We need to end these attacks by doing what Mr. Barnes recommends in the first post about Dr. Gitlow.  Physician supervision should be where it was designed to be—at the medical board.  If patients think they have been harmed by a doctor treating them, then they should lodge a complaint with the medical board. It is at that level that a doctor should be investigated, not criminal investigation for standard capitalist philosophy.

I believe in natural medicine. I’ve treated my patients with it, healing diseases that conventional medicine can’t touch.  If I had the business acumen to create a homeopathic company in America, I would. I would then recommend those products to my patients, prescribe them, and use them.  But would that make me a criminal?  It shouldn’t. It’s the American way.