Posted on Tuesday, 21st October 2008 by dcooley
One of the justifications for the Ryan Haight Act was that doctors performing face to face examinations can determine the veracity of a patient’s claim of chronic pain before prescribing medication much better than an internet pharmacy doctor performing an online consultation. This is likely true with respect to internet pharmacies that do not require medical records or online medical history questionnaires. However, is this so undoubtedly true for online pharmacy doctors requiring medical records and a phone consulation prior to writing a prescription to justify attempting to outlaw the practice altogether? I don’t think so.
Is there really any way to medically assess and objectively verify claims of pain? Is there a test one can perform, such as an MRI or other brain imaging technique? Is there anything that a face to face doctor performing a medical evaluation in his or her office could do that an online physician could not, assuming all else is equal? Let’s take back pain, for instance. What more does a face to face doctor do in the five minutes he or she sees you than look at the medical records, a patient’s medical and prescription history, and ask the patient what, where, and how long?
Today I came across a very interesting article written by the Boston Globe in 2006 noting that that researchers were attempting to utilize advanced brain imaging to detect prolonged, chronic pain.
Recent studies suggest that prolonged, ongoing pain leaves a signature in the brain that can be detected using advanced imaging techniques. In other work, researchers at Massachusetts General Hospital and elsewhere have found that excruciating nerve damage can be detected in bits of skin the size of a pinhead. And genetic tests may someday prove useful, researchers believe: Certain genes appear to be linked to lower pain thresholds and a tendency to develop chronic pain.
Most of the research remains years from helping patients, but as it comes to fruition, “what it means is that no longer can they say, ‘it’s all in your head,’ ” said Jim Broatch , who leads an advocacy group for people with a specific chronic pain disorder.
“With these objective and reproducible correlates in brain imaging, chronic pain may no longer be a subjective experience,” Lutz said in a press release.
As the article states, this technology is years away. Even if it wasn’t, I seriously doubt your local practitioner is going to perform, for example, an expensive MRI or a genetic test prior to issuing pain medication.
Thus, I once again ask the question, how can a face to face medical examination, as required by the Ryan Haight Act, verify claims of pain any better than an internet pharmacy doctor via an online phone, fax, or e-mail consultation after the review of a patient’s medical records, history, and prescriptions? I appreciate and welcome any thoughts.
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Tags: Controlled Substances, Criminal Appeals, Criminal Defense, Doctors, Internet Pharmacy Law, Non-Controlled Substances, Ryan Haight Act
Posted in Doctors, Online Consultations, Ryan Haight Act, Website Owners | Comments (6)
October 23rd, 2008 at 6:18 pm
Amazing we’ve never managed to invent something like a “pain-o-meter”. BP history is one indicator currently available as far as I can tell.
Where I normally have blood pressure in the ideal range, a few hours in immense pain and it shoots up wildly. I have my own BP machine here and can say with certainty there is a correlation.
No Doctor I’ve ever visited has made or acknowledged the relationship between the two, despite ready access to previous readings taken when my pain was being treated adequately.
I trust that those Doctors and researchers cited in the article get all the funding and support that they’ll need make such innovative testing part of the medical mainstream.
Of course, as you suggest, few Doctors would avail themselves of brain MRIs or genetic testing to determine if someone is suffering from intractable pain. These tests would need to develop to the level where they could determine degree of pain, not just the presence of pain to have any impact on general pain management by Doctors. Otherwise, the answer from most Doctors would still be “Just take some Aleve”.
Also would an even infallible test release even a willing physician from the undue scrutiny placed upon them if they treat patients with chronic pain compassionately? Not as long as we’re saddled with a medical establishment driven by DEA guidelines that fears even terminal patients may become “addicted”, I fear.
I do hope this research is encouraged for the benefit of the next generation. In the meantime, we need a general attitude change toward the treatment of pain as much as we need technology.
October 24th, 2008 at 2:23 pm
I have been looking for the exact law in summary to be able to understand the whole thing. Where would I get that?
Thanks
October 25th, 2008 at 1:51 pm
Ironic that during an Internet search for something entirely unrelated, I happened to come across this pain patient’s account among returned search results:
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So I guess I didn’t discover that relationship, but am surprised that more Doctors don’t use BP as a barometer of pain levels. Especially when given a benchmark level when the patient’s pain is treated, Clinicians can compare that to a reading taken when the patient complains of severe untreated pain.
I’ve got this anonymous, but credible seeming account beat. I’ve hit 160 and beyond at my worst although with medication I’ll normally measure 112/70 on average.
Perhaps we needn’t wait a generation for the admittedly promising DNA testing and advanced imaging to be refined.
Less fear on the part of the medical establishment to treat patients with painful conditions compassionately help Doctors weed out “fakers” with this seemingly acknowledged link.
Of course, this would require some face-to-face triage to be a reliable marker. However, many wouldn’t have to resort to online consultations if one’s Doctor accepted this measurement along with other traditional diagnostics that chronic pain might be present.
It’s often said that a “messy” spinal MRI may cause no pain for some people, yet those with a near “normal” MRI may experience considerable spinal pain.
However many of us with chronic back pain complaints, myself included, have the undeniably “messy” Lumbar and Cervical MRIs and most obviously have the pain too.
Otherwise they wouldn’t have had the MRIs ordered in the first place. Personally, I wouldn’t be sitting against this vibrating heating pad as I write just for kicks.
Debilitating back pain, while common, is also not the only type of pain that robs millions of a quality of life.
Doctors? Any comments? Care to take a BP reading now?
October 25th, 2008 at 2:00 pm
The quote I meant to cite from search results in the earlier post didn’t make it. While it was found by serendipity during a search for something unrelated, it’s proving elusive to include it here!
Perhaps my bracketing it got it mistaken for comment within a script code or a bad HTML tag….
So rather than appear crazy, I will reprint this seemingly sincere quote that I stumbled upon below:
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I just recently learned about pain affecting blood pressure. My blood pressure almost always runs between 110/70 to 120/80 but there has been a few times when I’ve gone to the doctor and it was high - like 140/90. I found out from my physical therapist that pain was most likely the reason for the elevated BP.
November 4th, 2008 at 12:22 am
[...] Undermining the Justification for the Ryan Haight Act: An argument that face to face physical examinations do not provide any advantages over online consultations in determining the veracity of a patient’s pain. [...]
March 12th, 2009 at 4:54 pm
[...] Analysis of the Justification for the Ryan Haight Act [...]