• Reducing deaths among drug misusers ~ (March 31 2001 editorial published in British Medical Journal)
  • General Medical Council may be destroying the British System ~ Arnold's Response
    • The current state of dependency management in the UK ~ Dr. Byrne responds to Arnold
      • Your letter raises many important issues ~ Arnold responds to Dr. Byrne
  • Standard of care in Britain was not addressed ~ Andrew Byrne's Response
• Authors' Reply

Your letter raises many important issues that will require much time to deal with. Here are a few preliminary thoughts.

I am convinced that medicine is more art than science and furthermore that addiction medicine is more like religion than anything else. By the latter I mean that I have observed over three decades that good physicians have often differed vehemently with one another about the best way to deal with drugs and addiction.

One approach of coping with this schism would be to declare as some countries have with religion that one method is truly better than others and then to declare a state religion -- or a single best practice method of handling addiction. To back this decision up, it becomes necessary to impose certain penalties on heretics in the form of excommunication or erasure or other sanctions imposed by some official body including the criminal law, the weapon most favored in the US.

I think that the best approach -- for religion and addiction medicine -- is to oppose establishment religions and all of the harms associated with that. This would require that we have the greatest possible freedom of medical practice, something akin to religious freedom. The baggage that comes with this approach is a good deal of chaos and also a good deal of experimentation and innovation. I prefer the disadvantages of the latter to the former.

I like standards and guidelines so long as they remain that and not canonical medical law. Coordination, training, education, clinical consultations, yes. Rigid rules backed up by professional destruction, no.

I believe that I trust most doctors more than most other doctors do. Certainly I trust doctors to make individual decisions about individual patients more than i trust policemen --including policemen in doctors' clothing -- to come in after the fact and make those decisions with perfect hindsight.

More to the point, I watched Ann Dally being destroyed for no reason on the basis of no rules that I was aware of. The same has happened to Patrick Hickey who is still fighting back with my blessing. Too many good doctors have had their reputations shattered on the basis of incomprehensible "best practice" rules that never seem to apply to those in power positions in medicine.

These are as I said simply thoughts for now.

More to come perhaps later.

All my best wishes.

Arnold