Who would you trust more: A fair-weather friend? A two-faced supposed buddy? Or an “enemy,” more precisely an adversary, who at least tells you straight-up what they think? If you ask me, take the adversary. I’ve argued to judges who smile and listen, then plunge a dagger in. And I’ve argued to judges whose eyes bulge and whose voices get loud and whose tempers flare. I always prefer the opinionated, vocal types to the silent cyphers, because if someone is talking with you and reacting, you at least know where you stand, and you have a better chance of prevailing.
So it is with doctors and the Federation of State Medical Boards, or FSMB. Doctors should not trust the FSMB to have their backs, even though the FSMB routinely and for decades has purported to operate in the interests of sound medical practice and robust patient safety, and has held itself out as a good doctor’s ally.
Years ago, it was the FSMB who along with Big Pharma advocated for widespread prescribing of opioid medicine for chronic pain. The FSMB even sponsored guidebooks on “responsible opioid prescribing.”
Fast forward to 2014:
1. There is a crisis of opioid overdose, addiction and death in the U.S.;
2. Drug companies continue to say that the problem is everyone’s fault but theirs,
with “everyone” being doctors and patients, but not the corporations who manufactured and marketed the drugs;
3. The FSMB has been under U.S. Senate investigation for possible conflict of interest and undisclosed financial ties to the drug companies; and,
4. The FSMB is revising its guidelines for opioid prescribing, under the auspices of giving doctors the updated and current information they need to practice safely and ethically.
Guideline revision seems innocent and helpful enough, right? But stop to consider these questions.
Is the guideline revision by the FSMB a carefully considered, scholarly and common sense response to changes in science and the standards of practice since the original and probably flawed studies about the safety of opioids for chronic pain were first published?
Is this a good faith effort by the FSMB to try and self-correct, and operate with transparency in a fast-changing field?
Is it a calculated public relations move in response to the Senate Committee’s close scrutiny of the possible coziness between the FSMB and the pharmaceutical industry in previous years?
In the final analysis, is the FSMB’s present move designed to help doctors and patients, or is the FSMB’s stated desire to help the situation just a cover for the organization’s trying to help itself, now that it’s under a very bright national spotlight?
Time will tell. But in the meantime, doctors should treat the FSMB’s moves and advice with great caution. If the FSMB isn’t blaming Big Pharma for the crisis, and it isn’t blaming itself – well, then, blame has to rest somewhere, and doctors are the only ones left!
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