OPINION
DOCTORS Lounge
CAN’T WE ALL JUST GET ALONG:
Medical Care, Not Politics
L
Larry Griffin, MD
et me make a few disclosures. I am
a physician, a veteran and a life-
long Republican, (though I have,
when appropriate, voted for other
parties’ candidates). I hope and
believe I am respectful of those whose opin-
ions differ from my own, though I reserve
the right to disagree respectfully with some
of them. I love my God, my family and my
country. I love the Navy and the Marine
Corps. I love my profession, and have de-
voted my entire professional life to an effort
to improve health care and outcomes for
women and their babies. I favor government
which provides for essential programs and
safety, but then stays out of our lives and
supports and encourages individual respon-
sibility. I support true safety nets for those
who really need them, but not for those
who simply choose to accept them in lieu of
being responsible for themselves and their
own choices and lifestyles. I do not accept
that throwing money at every problem is
the solution. I do not believe that when a
government program is given life, it should
necessarily be eternal. I do not believe we
can tax ourselves out of the debt quagmire
in which our politicians have placed us.
I voted for Donald Trump, and I support
most of his policies, though certainly not all,
and yet I am troubled by the apparent lack
of discipline he exhibits by his continual
off-the-cuff comments and tweets. As do
many of us, I do not believe either of the
candidates from which we had to choose
in 2016 fully measured up to the standards
we should expect of a president.
I am chagrined by the many people who
complain about the debt, rail against taxes,
and yet steadfastly hold to the opinion that
their favorite program or institution should
be protected against any budget cut, reduc-
tion in profile, etc. because in the overall
scope of a huge budget (federal or state),
their favored program is only a proverbial
drop in the bucket. No one questions the
value of the Arts, after school programs, etc.
but at some point, we have to set priorities,
and some things can no longer be support-
ed by public funds if we are to provide the
essentials for which we depend on govern-
ment in the first place. Additionally, with
enough “drops in the bucket,” that bucket
overflows, and the big bucket begins to look
drained.
Having said this, though I may sound
like a hard hearted, soulless individual to
some, I wish to make my own case for not
defunding a public program. Regardless
of what ultimately happens in the debate
about the Affordable (hardly) Care Act, or
its potential replacement, whatever it is be-
ing called today, there are programs which
have received funding which simply are too
valuable to remove, and which should not
only be funded at the current level, but given
additional funds. One of the most critical
today is treatment - effective treatment - for
narcotic use disorder. We simply must not
permit lack of funding for these patients to
curtail their treatment (which is long-term
by necessity), increasing relapse and the
complications which accompany it.
Every day, I become aware of more preg-
nant women affected by this disorder, result-
ing in complications not seen for years in
civilized societies: vegetative endocarditis,
amputations from septic injection sites, an-
tibiotic resistant sepsis, septic emboli with
strokes. The effect on their babies is equally
dire. They suffer from neonatal abstinence
with prolonged withdrawal, parental neglect
and abuse, prematurity and its associated
complications, stillbirth, and sudden infant
death. The list goes on and on.
Pregnant and postpartum women with
substance use disorder must remain in a
long-term treatment program in order to
prevent the very high rate of relapse seen
in this population. Such long-term care is
critical to any level of successful treatment.
Appropriate counseling, social support and
medication, if needed, are key elements of a
potential return to health and narcotic-free
life for both themselves and their children.
Politicians at all levels seem to have shift-
ed emphasis from a war on illegal drugs to a
war on legal, but misused ones. As a result,
legislatures across the country have passed
well-intended but, in my opinion, some-
times misguided laws to address this issue.
Better education and increased awareness
on the part of physicians is most appro-
priate, but some of the other regulations
enacted may be less so. A clear, unintend-
ed consequence is an increase in the com-
plications seen from an increased use of
illegal drugs with tainted contents and of
uncertain potency, as well as an increase
in the difficulty of patients who actually
have a medical need for legal drugs, to gain
appropriate access to them. I have not yet
seen compelling evidence that stricter legal
limits on pain medication prescribing effec-
tively decreases the incidence or severity of
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AUGUST 2017
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