Federal Government To Decide Prescriptions?


One of the most powerful aspects of true classical liberalism is the optimism it inspires in consistently adhering to the ideals of freedom and liberty. It lacks the narcissism and pessimism of socialism and avoids most of the purely reactionary foot-dragging traditionally associated with the more passive forms of conservatism.

However, rarely, do individuals make this point so perfectly. 

Kristen Gillibrand (D-NY) is going to tell physicians how to prescribe medication. The government knows better than physicians in their minds.

She’s not a physician. She is not a dentist. She has never prescribed medication. She has never performed a procedure. She has never had a patient in her clinic with intractable back pain after spinal fracture trying to go back to work. She doesn’t have a Drug Enforcement Agency license to prescribe narcotics. It’s at least mildly condescending to assume that such a complex physician-patient decision can be made by one single government decree.

First, as is the challenge with central planning it becomes unworkable. Which seven-day supply would the Senator prefer for my patients? Sometimes we prescribe medication to be taken every four hours, and sometimes it’s every eight hours. In certain rare circumstances, we need medication every two hours. This tends to be more common in children. We have 5mg dosing and sometimes we have 10mg dosing. Also, different drugs have different potency and bioavailability. Which ones will the State allow?

Second, does she really understand what she is talking about? I’m very curious to learn her thoughts on the possible impact of manipulating the different opioid receptor pharmacological subtypesμ-opioid, δ-opioid, and κ-opioid receptors. Also, how is she planning to deal with the downregulation during the transformation of opioid naïve patients during inpatient hospitalizations? Also, I would be most interested to learn how her legislation will account for the subset of the population that has a genetic mutation that prevents normal doses of opioids from working? And so on.

Then there are the mechanical issues. Since patients will still be in the same amount of pain they will now return to clinics on a more regular basis for pain refills bogging down the system. For patients, this means more days of missed work and more transportation hassles. Naturally, for those with fewer means, this will have the greatest impact. 

One would be more sympathetic to this sanctimonious purge against big Pharma industry except that Kristen Gillibrand was a lawyer for big tobacco in the 1990s. 

The then Kristen Rutnik, was a pivotal attorney for Phillip Morris protecting and guiding the company as it navigated lawsuits about cigarettes’ link to cancer and addiction. She even traveled to the company’s lab in Germany and sought to limit the government’s ability to use and prosecute such information. She wasn’t passive in the process. She oversaw a team of associate lawyers while working for the firm of Davis Polk & Wardwell from 1991 to 2000.

The difference now is that she doesn’t want to make money she wants to be President.

That’s the dangers of populism and planning. They are at the whim of a malleable reactionary response to the issues most vocal emotional respondents. The crusading Senator will not be rescuing patients from the evil vice-grip of physician’s reckless prescribing habits while simultaneously protecting patients from evil corporations. Rather she will introduce a bad policy that will not solve the problem and will potentially hurt real people.   

Without question, reform and action items are necessary. A single absolutist government decree is never the answer. Innovations and reasonable reform are on the way. It’s worth noting that even the government can’t stop pain. It will just stop legal access to pain medication. This turns more people on to dangerous and illicit drugs like heroin and synthetic fentanyl. Jacob Sullum and Jeffrey Singer have written vociferously about this. Limiting access to pain pills puts more patients in dangerous circumstances.

This is just another example of generally well-intended people trying to solve complex problems with a government apparatus. It rarely solves the problem and almost always creates unintended outcomes with serious consequences.  

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Dr. Richard Menger

Richard Menger MD MPA is a neurosurgeon, graduate of the Harvard Kennedy School of Government, and a member of the Foundation for Economic Education faculty network. He is a lead editor of the textbook “The Business, Policy, and Economics of Neurosurgery”.