Pain and Punishment
Psychiatrist Sally Satel’s piece “Treating Opioid Addiction” (March 6) favors “benign paternalism” in public policy regarding what some have hysterically called an “epidemic” but Dr. Satel more soberly calls a “crisis.” What caused this crisis? According to Dr. Satel, it all started when “patient advocates” and “narcotics manufacturers” encouraged some physicians to “over-prescribe” medications for such minor ills as “toothaches.” However, having said so, Dr. Satel immediately acknowledges that “the average drug abuser is not a person being treated for pain” but someone who “obtains pills from friends, shady doctors, or street sellers.” Just so. But if the main cause of the problem is neither misbehavior by physicians nor misbehavior by patients, why has the main response by government been to discourage conscientious physicians from prescribing seriously needed pain medication to responsible patients?
Sally Satel responds: Mr. Hocutt puts his finger on a major tension: how to deliver good pain treatment while curbing abuse of prescription painkillers. The justification behind practices such as prescribing smaller amounts of medication and using prescription-monitoring programs is not to disadvantage pain patients, but to keep painkillers such as Vicodin and OxyContin out of general circulation, where they are prone to abuse by others. Patients with chronic pain are understandably worried and upset about being caught in a dragnet not intended for them. Better education for clinicians in managing both pain and the prescribing of opioids is one answer, but it won’t happen overnight.
Command and Control
Kevin D. Williamson’s article “Progressivism in the Boardroom” (March 6) exposes the liberal-corporate-executive command-and-control mentality. “The boss is always right even when he’s wrong” is difficult to challenge. Williamson did not touch upon the group psychological manipulation taking place on school boards and in corporate board rooms. Several books explain the “how to” and “positive side” of group psychological manipulation. CEOs and superintendents see nothing ethically wrong with developing strategic-planning consensus in this fashion; indeed, they are supported by human-resource companies, some listed on the New York Stock Exchange. Board members and employees know something is wrong but can’t quite put their fingers on it. In 2002, Beverly K. Eakman wrote a book titled “How to Counter Group Manipulation Tactics” and subtitled “The Techniques of Unethical Consensus-Building Unmasked.” It should be required reading for anyone with a command-and-control boss.
Myrtle Beach, S.C.