THE NEW YORK TIMES
Silent Until Today...
(Times Letter Follows)
Dear Mr. Okrent,
I have written your office on several other occasions and have not received a
reply. Following the Times' failure to cover the criminal trial of Dr.
William Hurwitz and the pain movement that is being crushed by the United States government, I felt that I had to voice my complaint again and request a meeting with you.
I supplied Adam Liptak with a letter from 6 former presidents of the American
Pain Society denouncing the testimony of the government's key expert witness
against Dr. Hurwitz. The language could not have been stronger, an astonishing
political development-that has again, gone unreported.
I have spoken to several reporters at the Times who made it clear that the
paper was aware of the trial and of the other cases that PRN is supporting, we
were yet again on the front page of the Washington Post when Dr. Hurwitz was convicted, the DEA withdrew its FAQ document and has since openly intimidated the medical community with a new statement of the law-the intimidation acknowleged by the AMA! and still nothing from the New York Times.
Celebrex and Vioxx have been shown to be tremendously dangerous and have been
withdrawn from the market while opioids are nontoxic to major organ systems
but their availability is actively suppressed by the US Department of
Justice - we have a CSA that judges drugs according to law enforcement notions rather
than scientific ones, and still the New York Times cannot find the story.
Patients and doctors are intimidated. Families are being ruined. Physicians
are being required to act as policemen in the doctor patient relationship-the
DEA says that doctors acting in good faith have nothing to fear and the SAME
DAY that Tandy announces this "reassuring" position in USA Today, the US
Attorney prosecuting Hurwitz asks the judge to leave the good faith instruction out
of his charges to the jury which this unapologetically biased judge did.
Dr. Hurwitz had his 2 million dollar bond revoked and was thrown in jail
immediately - someone who could not again commit the crime he had been convicted
of - and still nothing.
What, Mr. Okrent, does it take to persuade the New York Times to cover this
I live in New York City and will be available to meet at your convenience.
Given the fact that your paper looked at the ethical problems surrounding Barry Meier's reporting and gave yourselves a clean bill of health, I would have
thought you would be eager to avoid any more misunderstandings regarding your
coverage of the pain issue. I must say that I am shocked by your paper's
failure to cover this story.
Thank You for Your Prompt Attention to This Matter,
Family Member of a Chronic Pain Patient
Pain Relief Network
'Standing up for patients in pain and the doctors who treat them'
(212) 873-6755 fax
THE TIMES Response:
Dear Siobhan Reynolds,
Because you mentioned Adam Liptak, I was able to ask him about his
decision not to cover the Hurwitz trial. But as you have apparently spoken with
or tried to reach many people at The Times, I really can't give you a
persuasive answer as to why the paper hasn't covered the PRN. If you would send me a
summary indicating whom you have approached and what the response was, I'd be
able to look into it with some chance of finding out the answer.
You'll note that I do not respond to your urging that The Times cover
the story; that's because my job is to criticize what's in the paper; I have
no role in determining coverage. But if I can get a sense of why The Times has
failed to cover the story, it could at least enable me to address that part
of the equation.
N.B. Any opinions expressed here, unless otherwise attributed, are solely my
Thank you for your response. I dont think that polling the individual
reporters will be helpful. The problem seems to stem from the Times' failure to fully account for the wrong-headedness of its reporting on this issue when Barry Meier was covering it. Law enforcement throughout the United States has
prevailed upon otherwise level headed reporters to trumpet a drug scare regarding Oxycontin, much to the grave detriment of patients in pain, their families, and the doctors who had been treating them. This drug scare precipitated a spate of prosecutions which can only be characterized as a witchhunt. Witchhunts are terrible things, Mr. Okrent, and they must be exposed.
When you have a witchhunt occur on a national scale as we have here - and the inflammatory aspersions are cast by the government - exciting the raw nerves exposed by the terror attacks of 2001 - the damage done is truly cataclysmic.
The Orlando Sentinel apologized for the role it played here but the Times
read its ethical mandate narrowly and found that Meier's reporting had been
accurate. Despite giving yourselves a clean bill of health, your paper then ceased reporting the story all together.
The complaint, at least from PRN and the people in pain we represent, isn't
that Meier's reporting was inaccurate like the Sentinel's was, it is that it
was premised on assumptions which themselves are terribly prejudiced and which
are wholly dismissive of the fundamental legitimacy of our claim that we merit
treatment for our disease-pain.
Meier also simply refused to face the fact (supported by the wealth of the
literature) that people in pain do not get iatrogenically addicted to opioids.
He doggedly held to his view that these meds are "highly addictive" when the
studies show that they are not.
So if you wanted to re-approach the problem from an ethical standpoint, I
suppose you could take another look at Meier's reporting in light of the fact
that it was self-serving to a degree not befitting a national reporter. And if
that would get us to the point where the reporters at the Times would feel free
to investigate what we are telling them, in an open and unprejudiced fashion,
then by all means start here.
The main thing is to get the Times moving on our story. Every day that you
dont tell it is a day that the patients are being destroyed and our doctors are
being incarcerated and intimidated.
We are calling for a US Commission on Pain and a thorough examination of the
methods employed by the government in procuring all these wrongful
convictions. Until the people are made aware of what is happening to ill Americans in
pain, on our soil, we will not be able to move the Congress to protect us from
the Executive branch. The press' role (and therefore the Times' role) in the
proper functioning of our democracy is well understood and is, I trust, a subject
of interest to you as public editor.
Dear Mr. Okrent,
In my previous communication I mentioned that Mr. Meier's articles and book
were based on the false premise that opioid analgesics are highly addictive
when used in the treatment of chronic pain. I mentioned scientific
literature that demonstrates that this is in fact not the case.
The fact that Mr. Meier overlooked this widely available scientific evidence
in his zeal to participate in a government generated drug panic is
understandable as human error. The fact that he has been aware of this
evidence for more than a year, but refuses to address its implications,
represents a breach of his, and your newspaper's obligations to its readers
and the general public. The American people continue to be misinformed and
injured by this ongoing ethical lapse.
I have pasted the relevant citations, along with a synopsis of each.
These surveys provide evidence that addiction is exceedingly rare during
long-term opioid treatment of cancer pain and does not commonly occur among
patients with no history of abuse who receive opioids for other medical
Friedman DP. Perspectives on the medical use of drugs of abuse. J Pain
Symptom Manage 1990; 5(1 Suppl):S2-5.
The treatment of severe pain requires the use of potent opioid analgesic
medications. Many patients with opioid sensitive pain are being
undermedicated. This results in increased morbidity and needless suffering.
The most important reason for this undertreatment is the fear of addiction
engendered by opioids, a fear that is greatly out of proportion to the real
risk. The risk of addiction is greatly overestimated in part because many
people do not understand the distinctions between drug abuse and drug
addiction, on the one hand, and physical dependence and tolerance, on the
other. Dependence and tolerance are virtually inevitable outcomes of
long-term opioid use, but they are neither sufficient to cause addiction nor
the equivalent of it. Indeed, the evidence shows that only a tiny fraction
of patients treated with opioids become addicted. There is little risk of
addiction for those patients receiving properly administered opioids for
Medina JL, Diamond S. Drug dependency in patients with chronic headaches.
Headache 1977; 17: 12-14.
This survey of patients treated at a large headache center during 11 months
could only identify three problem cases (two codeine and one propoxyphene
abuser) among the 2,369 patients who had access to opioid analgesics.
Kanner RM, Foley K. Patterns of narcotic drug use in a cancer pain clinic.
Ann NY Acad Science 1981; 362: 161-172.
This analysis of the patterns of drug intake in cancer patients receiving
chronic opioids suggests that the medical use of opioids rarely leads to
drug abuse or to iatrogenic opioid addiction.
Schug SA, Zech D, Grond S, Jung H, Meuser T, Stobbe B. A long-term survey of
morphine in cancer pain patients. J Pain Symptom Manage 1992;7:259-66.
This study identified one case of substance abuse among 550 cancer patients
who experienced pain and were treated with morphine for a total of 22,525
treatment days. Physical dependence posed no practical problem in
discontinuation of morphine treatment. Long-term opioid intake and
development of tolerance did not appear to be linked; an increase in
morphine dosage was most often explained by progression of the terminal
Perry S, Heidrich G. Management of pain during debridement: a survey of U.S.
burn units. Pain 1982; 13:267-280.
In a survey of burn facilities in the US, 181 staff members from 93 burn
units were asked how many cases of actual iatrogenic addiction could be
documented following the administration of narcotics for pain control in
burned adults and children. Respondents with an average of 6 years of
experience caring for at least 10,000 hospitalized burn patients found no
case of addiction in patients treated for burn pain.
Portenoy RK, Foley KM. Chronic use of opioid analgesics in nonmalignant
pain: Report of 38 cases. Pain 1986; 25: 171-186.
38 patients were maintained on opioids for severe, chronic noncancer pain;
half received opioids for four or more years, and six of these were treated
for more than seven years. About 60% of the 38 patients reported that their
pain was eliminated or at least reduced to a tolerable level. The therapy
became problematic in only two patients, who both had a history of drug
abuse. The authors provide guidelines for monitoring patients requiring
opioid maintenance therapy.
Zenz M, Strumpf M, Tryba M. Long-term oral opioid therapy in patients with
chronic nonmalignant pain. J Pain Symptom Manage 1992; 7: 69-77.
This large survey described 100 patients with diverse pain syndromes who
received dihydrocodeine, buprenorphine, or morphine for prolonged periods.
More than half of these patients maintained greater than 50% analgesia for
at least one month and performance status increased overall, with the
largest improvement observed among those with the greatest relief of pain.
No incidents were reported of serious toxicity or drug-related behaviors
suggestive of addiction or abuse.
Moulin DE, et al. Randomized trial of oral morphine for chronic noncancer
pain. Lancet 1996; 347: 143-147.
This study used a cross-over design to compare the opioid against a placebo
(benztropine) to ensure blinding of the therapy. The study evaluated a broad
range of outcomes related to subjective effects and function. The results
demonstrated a significant reduction in pain during morphine therapy,
without change in physical or psychological functioning, and without
evidence of psychological dependence or aberrant drug-related behavior.
Brookoff D, Palomano R. Treating sickle cell pain like cancer pain. Ann
Intern Med 1992; 116: 364-368.
In this survey, patients treated for sickle cell pain at a university-based
clinic were prescribed opioids following the model based on the treatment of
cancer pain. During a two-year follow-up period, emergency room visits
declined by 67 percent and hospital admissions decreased by 44 percent. No
increase in opioid abuse was reported.
Chapman CR, Hill HF. Prolonged morphine self-administration and addiction
liability: evaluation of two theories in a bone marrow transplant unit.
Cancer 1989; 63: 1636-1644.
Using data obtained from patients in a bone marrow transplant unit, this
study examined addictive behavior in patients who self-administered
intravenous morphine in comparison with patients who received the drug via
routine staff-controlled continuous infusion procedures. Self-administering
patients used significantly less morphine than controls and still achieved
the same amount of pain control; moreover, they terminated drug use sooner
than controls. The results support the assumption that self-administration
of opioids in a medical setting does not put patients at risk for
over-medication or addiction.