The Ecstasy Factor

Bad Science Slandered a Generation’s Favorite Drug. Now a New Study Aims to Undo the Damage. “On February 24, the DEA issued Dr. Michael Mithoefer a Schedule I license to legally obtain Ecstasy for a study of its potential therapeutic effects in the treatment of PTSD. Researchers hope that the drug, which melts anxiety, will help PTSD patients talk openly about the experiences that scarred them. It is the first study of Ecstasy-enhanced psychotherapy ever green-lighted in the United States, one that’s been in the making for almost two decades. ‘There’s been so much struggle over this approval process,’ says Rick Doblin, director of MAPS, the Multidisciplinary Association for Psychedelic Studies, the organization sponsoring the research.” —Village Voice

In Texas, Hire a Lawyer, Forget About a Doctor?

“You can sue but you can’t hide”: “For months, an obscure Texas company run by doctors has been operating a Web site, DoctorsKnow, that compiles and posts the names of plaintiffs, their lawyers and expert witnesses in malpractice lawsuits in Texas and beyond, regardless of the merit of the claim.” —New York Times

For a small monthly fee, subscribers were able to search the site to “assess the risk of offering your services to clients or potential clients”, as well as add names to the database “from official and unofficial public records.” While the site took pains to counter claims that it is a blacklist by acknowledging that some malpractice lawsuits have merit, the potential for abuse is clear.

Indeed, after being publicized in the New York Times and elsewhere, the site has ceased operation, citing the public outcry.

DoctorsKnow.Us has permanently ceased operations as of 3/9/04. The controversy this site has ignited was unanticipated and has polarized opinions regarding the medical malpractice crisis. Our hope is that this controversy will spark a serious discussion that results in changes that are equitable to both patients and physicians. All charges that have been collected will be returned to members and trial members.

I suspect, rather, that it was the threat of a lawsuit from someone who the site has ‘blacklisted’ that led to this rapid response. [What do you expect when you create a listing of litigation-prone individuals?? Since the site did not attempt to differentiate lawsuits with merit from those brought in a ‘frivolous’ (I hate the term, because the people who bring ‘frivolous lawsuits’ are doing it in anything but a spirit of frivolity), i.e. ‘predatory’, manner, they are vulnerable potential lawsuits both from patients whose ability to have legitimate medical needs met was damaged or potentially damaged by their listing and from those whose interest in bringing suit is more opportunistic and predatory.]

But the premise of the site ignores the notion that vulnerability to a malpractice suit may have more to do with the manner in which the physician conducts her or his practice than the nature of the patient. I am not just talking about avoiding the sensational, egregious errors or abuses we hear about in the news, like amputating the wrong leg or taking out the wrong kidney or, in my own field of psychiatry, sleeping with your patient. Long ago, at the beginning of my training, I read an article making the radical proposal that the best way to avoid malpractice suits was to practice without malpractice insurance. While that suggestion was abit too waggish to risk, the point is a good one. If, as a health care provider, you practice as if the only thing that protects you against the consumer dissatisfaction and ire of your patients is your good graces, you have gone a long way to defuse the risk you face. Readers of FmH know I have urged you to consider yourselves entitled to get adequate explanations for your provider’s medical decisions and have final discretion about all decisions affecting your health care. Unfortunately, this collaborative or consultative model of the relationship between physician and patient is the first victim of the pressures of the modern productivity-driven healthcare system. If ever taught in the medical school curriculum, it is during the first year, to be scoffed at and rapidly forgotten as soon as the student hits the wards for clinical rotations and never resurrected thereafter.