George D. Lundberg
Physicians and Lawyers for National Drug Policy: A Public Health Approach
April 20, 2004
National Press Club, Washington, DC
10:00 – 11:00 AM
Thank you very much for coming today and good morning everyone. I am Dr. George Lundberg, Editor-in-Chief of Medscape General Medicine from WebMD, and Co-Chair of the new Physicians and Lawyers for National Drug Policy.
A drug may be defined as “any chemical, which when administered to a living thing, produces an effect.” I define drug abuse as “the use of a drug in manner that may be calculated as likely to cause harm—predictable harm.” Any drug can be abused but the ones that cause the most trouble are the psychoactive drugs. A psychoactive drug is one that affects the way you think, feel, or behave.
Through all of recorded history, there have always been drug abuse and drug abusers. There is no reason to believe that there will not always be drug abuse and drug abusers, as long as humans are frail and drugs are available. The long-term key effort that humans have made to get rid of the drug problem has been to get rid of the drugs. No drug, no drug problem. Pretty simple. The problem is that that approach never has worked. Does not work in Washington, DC in 2004. Does not work in your town. No reason to believe that it ever will work in anything approaching a free society. Strong, effective drugs are too easy to make, get, and use, and the drive to take them is overwhelming to many people. I am reminded by another press event happening down the hall this morning on the Oceans, of the statement made by Oliver Wendell Holmes, addressing the Massachusetts Medical Society in the mid-19th Century “I am quite convinced that if the whole of materia medica were dumped into the ocean, it would be all the better for mankind and all the worse for the fishes.” But that won’t happen so we have to figure out how to handle the drugs that are and will be virtually omnipresent.
So why are we here today? We are here to express the belief that we, as an organized society, can do a better job with the drug problem, while recognizing that we will never completely solve the problem in the lifetime of anyone in this room today.
We are in Washington, DC, where there is a lot of talk these days about accountability, and the lack of accountability.
We, representing leading physicians and lawyers, intend to move aggressively toward requiring accountability of those in our society, both in and out of government, in the field of substance abuse. Accountability that drug control policies, both national and local, become more evidence-based, and that their implementation in legal and medical practice, be more evidence-based.
What is evidence-based medicine? Its founder, Dr. David Sackett defines it as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external evidence, and neither alone is enough.”
Why physicians and lawyers? In practice, where does the buck stop? It stops in the physician’s office, where the patient presents with a problem with alcohol, tobacco, or other drugs. It is the physician’s responsibility to recognize that problem and turn it into an opportunity for intervention and treatment. The same applies in spades to the physician in the emergency department and in the hospital. The buck stops with the lawyer, be he or she in civil or criminal practice, prosecution or defense, when the victim of drug abuse presents with divorce, domestic violence, automobile driving problems, and on and on. The buck stops with the judge, before whom drug problems are ever present, who must seek to render justice, within the law, to the individual, to other participants in the problem at hand, and to society at large.
When any and all efforts at primary and secondary prevention, treatment and rehabilitation fail, an all too frequent event, the buck stops with my friends and colleagues, the pathologists, in the morgue, and especially in the medical examiner-coroner’s office with the forensic pathologist, when it is indeed too late for that person, but not for others.
Do the drugs kill? Yes--often. How do the drugs kill? Each has its own toxicology. Alcohol and tobacco are by far the most lethal; heroin next, and then all the others down from there-by overdose, medical diseases, and violence of many kinds.
Why PLNDP? Dr. David Lewis had the idea about 7 years ago that physicians had been on the sidelines of this issue for far too long and that physician leadership was lacking. He convinced about 3 dozen of the rest of us to join together in forming the original Physician Leadership on National Drug Policy. All members of the original group had huge name recognition and commanded general respect. Significantly, few of the leaders worked directly in the drug field. This was intentional so as to prevent any criticism or allegations of financial conflicts that can undermine so many activities.
What did the original PLNDP accomplish? Much--mostly education--huge amounts for many individuals and groups.
Why change the organization to Physicians and Lawyers for National Drug Policy? Early on in this process, it became obvious that in our culture, the drug buck does stop with physicians, but also with lawyers and judges, all of whom have great opportunities, and I would say, responsibilities to recognize the problems, as early as possible, and to use their skills and the power of their positions to do the right things, for individuals and for society. And, whenever possible, to be redemptive, not punitive.