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Wednesday, April 3, 2019

Kirsten Gillibrand Is Going to Tell Physicians How to Prescribe Medication

Reform is necessary, but a single absolutist government uniform tweet-level decree is never going to be the answer.

Image Credit: Flickr-AFGE | CC BY 2.0 (

One of the most powerful aspects of truly principled classical liberalism is the optimism it inspires by consistently adhering to the ideals of freedom and liberty. It lacks the narcissism and pessimism of socialism, and it can avoid most of the purely reactionary foot-dragging traditionally associated with more passive forms of conservatism. 

However, rarely do individuals make this point so perfectly. 

Kirsten Gillibrand (D-NY) is going to tell physicians how to prescribe medication. The government knows better than physicians.

She is not a physician. She is not a dentist. She has never prescribed medication. She has never performed a procedure.  She has never had a patient in her clinic with intractable back pain from a spinal fracture trying to go back to work. She doesn’t have a Drug Enforcement Agency license to prescribe narcotics.  It’s at least mildly condescending to assume that such a complex physician-patient decision can be made by one single government decree.

Impractical Blanket Solution

First, as is the challenge with central planning, it becomes unworkable. Which seven-day supply would the senator prefer for my patients? Sometimes we prescribe medication to be taken every four hours, and sometimes it’s every eight hours. In certain rare circumstances, we need medication every two hours. This tends to be more common in children. We have 5mg dosing and sometimes we have 10mg dosing. Also, different drugs have different potency and bioavailability. Which ones will the government allow?

Then there are the mechanical issues. Since patients will still be in the same amount of pain, they will now return to clinics on a more regular basis for pain refills, bogging down the system. For patients, this will simply create more days of missed work and more transportation hassles. Naturally, this will have the greatest impact on those with fewer means.

The difference now is that she doesn’t want to make money. She wants to be president.

One might be more sympathetic to this timely, sanctimonious outcry against big pharma if Kristen Gillibrand hadn’t been a lawyer for big tobacco in the 1990s. 

The then-Kristen Rutnik was a pivotal attorney for Phillip Morris, protecting and guiding the company as it navigated lawsuits about cigarettes’ link to cancer and addiction. She even traveled to the company’s lab in Germany and sought to limit the government’s ability to use and prosecute such information. She wasn’t passive in the process. She oversaw a team of associate lawyers while working for the firm of Davis Polk & Wardwell from 1991 to 2000.

The difference now is that she doesn’t want to make money. She wants to be president.  

Dangerous Consequences

That’s the danger of populism and planning. They are at the whim of a malleable, reactionary response to the issues’ most vocal, emotional respondents. The crusading senator will not be rescuing patients from the evil vice-grip of physicians’ reckless prescribing habits while simultaneously protecting patients from evil corporations. Rather, she will introduce a bad policy that will not solve the problem and will potentially hurt real people.

Without question, reform and action items are necessary, but a single absolutist government uniform tweet-level decree is never going to be the answer. Innovations and reasonable reform are on the way. It’s worth noting that even the government can’t stop pain. It will just stop legal access to pain medication. This turns more people on to dangerous and illicit drugs like heroin and synthetic fentanyl. Jacob Sullum and Jeffrey Singer have written vociferously about this. Limiting access to pain pills puts more patients in dangerous circumstances.

This is just another example of generally well-intended people trying to solve complex problems with a blunt government apparatus. It rarely solves the problem and almost always creates unintended outcomes with serious consequences.

  • Richard Menger MD MPA is a neurosurgeon and a graduate of the Harvard Kennedy School of Government. He is a lead editor of the textbook "Economics, Business, Policy of Neurosurgery." He is currently the Chief of Complex Spine Surgery at the University of South Alabama and is on the faculty of the neurosurgery and political science departments.