by Portenoy, Campbell,
Cleeland, Miaskowski, & Payne.
Submitted to Judge
Originally posted: 12/19/2004: [www.doctordeluca.com/Library/Hurwitz-PastPresAPSonAshburn04.htm].
The Hurwitz Collection ;
The War on Pain
Sufferers special collections
Appellant William Eliot Hurwitz -
Robbins, Russell, & Taaffe; 2005 (Summer)
[260 KB PDF]
Amicus Curiae - Association of American Physicians & Surgeons
L. Schlafly, Attorney for Amicus Curiae; AAPS; 2005-09-06
Relief Network letters to Judge Wexler in support of Dr. Hurwitz:
Siobhan Reynolds //
War on Doctors/Pain Crisis blog
and RSS feed
December 10, 2004
Marvin D. Miller, Esq.
P.O.Box 663, 1203 Duke Street
Alexandria, VA 22313
Dear Mr. Miller,
We are Past-Presidents of the American Pain Society and have decided to take an
unusual step in writing you about the expert testimony that you have heard at
the trial of Dr William Hurwitz. We are deeply concerned that serious
misrepresentations in the testimony provided by the government's expert, Dr.
Michael Ashburn, will undermine the welfare of patients who suffer in chronic
Our concern is that the role of key government expert will lend credibility to
Dr. Ashburn's statements about the treatment of chronic pain, many of which we
believe to be factually wrong or serious misstatements of consensus in the
field. The credibility accorded this testimony, when disseminated or used to
justify future investigations, threatens the public good. We felt morally
compelled to inform you of our profound concern.
There are several points of sharp disagreement:
repeatedly stated that the use of "high dose" opioid therapy is an
indication of drug abuse in populations with chronic non-cancer pain. It is
factually untrue that this is a consensus opinion of pain experts. We
strongly hold the view that patients with non-cancer pain may benefit from
opioid therapy and that the dose necessary to control pain may be high. Use
of "high dose" opioid therapy for chronic pain is clearly in the scope
Dr. Ashburn asserts
(page 23 of the transcript) that morphine at a dose of 195 mg/day
constitutes a high dose. This statement is without foundation in the medical
literature and we believe that it is, on its face, absurd.
Dr. Ashburn implies
that opioid treatment of a patient with a known addiction is medically wrong
and worsens the addiction. This is not the view of experienced clinicians in
the field. It is unacceptable to promulgate the view that the disease of
addiction automatically denies patients with severe pain the possibility of
relief through careful opioid therapy.
He states (page 37)
that high dose opioids produce hyperalgesia (increased pain) and therefore
may worsen the clinical pain problem. Although this has been raised in the
literature as a theoretical concern affecting some patients, neither the
prevalence nor the clinical significance has been established and its
putative risks have not led to any change in clinical guidelines.
speculates (page 37) that high dose opioids may compromise the immune
system. Again, this is considered to be a theoretical risk, one balanced by
the potential dysimmune effects of unrelieved pain itself; it has not found
its way into any accepted guideline for opioid use in any population.
In the past, each of us
perceived Dr. Ashburn as a respected colleague and his selection as an expert by
the government as understandable. We are stunned by his testimony. As leaders in
this field, we feel compelled to correct the errors in his testimony, lest it be
used in the future in a manner that worsens the national tragedy of untreated
pain. We will try to correct the public record after the trial concludes and
sincerely hope that the government and the court will consider this information
Russell K. Portenoy MD
Chairman, Department of Pain Medicine and Palliate Care
Beth Israel Medical Center
New York, New York
Professor of Neurology and Anesthesiology
Albert Einstein College of Medicine
Bronx, New York
Chief Medical Officer, Continuum Hospice Care/The Jacob Perlow Hospice
New York, New York
James N. Campbell, M.D.
Director, Blaustein Pain Treatment Center
Johns Hopkins University Medical Center
Kathleen Foley, M.D.
Pain & Palliative Care Services
Memorial Sloan-Kettering Cancer Center
Charles Cleeland, Ph.D
Director, Pain Research Group
U.T.M.D. Anderson Cancer Center
Christine Miaskowski, R.N. Ph.D. FAAN
Professor &Chair, Department of Nursing
University of CA San Francisco
Richard Payne, M.D.
Director, Duke University on Care at the End of Life
Duke University Divinity School