Let us imagine a perfect world, where the government does nothing but protect our rights from one another, defends us against foreign aggression and settles civil court cases. But even in such a perfect world, you may suffer some sort of health problems. Let us imagine you do, and let us also imagine that it is a condition causing chronic pain, such as my own (undiagnosed) condition. In this perfect world, you would go to your family doctor and describe your condition. If he thought you were in enough pain, he would prescribe medication¹, be it anti-inflammatory or opiates. He might also send you to a specialist, or he might not. If you went to see a specialist, and he decided it was a chronic condition which would not respond to any treatment, he would write you a long term prescription for the necessary pain medications. And that would be it. The same way diabetics get insulin prescriptions which last months, or digitalis prescriptions come with multiple refills, pain medication would also be just another medicine.

However, we live in nothing like a perfect world. In fact, we don't even have anything like a perfect government^2,3.

Let us start with the first time the government enters into your interactions with your doctor. In our ideal world, you would go to your doctor and tell him your symptoms, he would decide what you were describing and prescribe or suggest treatment as he saw fit. In our world, he has to immediately ask if you are a "drug seeker". Thanks to recent prosecution, even if he has no idea you are, even if there is little or no evidence, he might be at risk if it turns out you are "doctor shopping". And so, thanks to the government, your doctor no longer is your employee, whom you pay to provide advice, he is now an agent of the government, charged with deciding if you are involved in misbehavior, and ready to refuse service if he suspects you might be doing something of which the state disapproves.

Nor is that the only place where the government changes this basic relationship. In an ideal world, the doctor would diagnose and prescribe based on his medical judgment, your preferences for treatment and your ability to pay alone, but not any longer⁴. Now, he has to ask if the government will think he is prescribing too soon. So, he tend to under prescribe pain killers, if he prescribes at all. Far more likely, to provide cover for himself, he will first try a series of treatments, whether he thinks them likely to work or not. He may also choose the form of treatment based on government regulations, for instance, favoring implanted pumps which put the drug directly in the spinal fluid, rather than prescribing, as the government prefers it since it prevents "diversion" of the drug⁵.

But the changes do not stop there. In order to avoid government investigations, or to provide cover when they are investigated, doctors come up with a variety of insulting solutions. These range from "medication agreements", which try to prevent you from receiving pain medication from any other doctor, changing pharmacies, or performing a host of other legal actions, to demanding urine tests on a regular basis to ensure you are taking your medication, and not taking anything else. For that matter, some doctors, who specialize in treating those with "drug problems" actually require patients to come to the office daily to receive their medication.

And it is not only doctors, pharmacies and insurers get in the act too, writing to your doctor and the government when they detect "suspicious" patterns of prescriptions. It is bizarre, in our age, with so many obsessed with "privacy rights", we have favored government regulation which obliterates all privacy and turns shop keepers and employees into informants, all to ostensibly protect us from ourselves⁶.

Some will doubtless argue that I am making too much of one small area of the law. As they support the laws against drug use, and think it the proper role of government to prevent individuals from consuming the wrong substances, they imagine that this loss of freedom and this twisting of normal human relationships is acceptable.

But it is not just doctors. Thanks to government regulations, such as OSHA, or EEOC, there are incentives for employees to spy on employers, HR staff to turn on their employers to protect themselves, and applicants to entrap potential employers in dubious statements in order to extort a position^7,8. Because government laws tend to create civil or even criminal liability, and the easiest way to avoid such liability should it occur is to find someone else to blame, government intervention in any field tends to create situations where offices become "dog eat dog". As I described in "Somewhat Off-Topic Rants", this was once the province of government offices, where blame avoidance was paramount, but with the spread of government into the private sector, it has made the private enterprise world look a lot like the backstabbing, traitorous government office, and turned individuals against one another as they play "CYA" or even try to turn government regulations against one another.

Some may argue that if you are doing nothing wrong, there is nothing to fear. And I agree, in the case of criminal laws, for example, at least those that are well written and precise. No one, for instance, worries about wrongful murder charges, and, if your office does regularly commit murders, then I have no problem with your staff suffering extra headaches. But when laws are vague, or criminalize normal behavior, then I do have a problem. For example, EEOC basically criminalize statistic anomalies in hiring patterns. As employers are rarely aware of what statistical imbalances might or might not be subject to investigation, this effectively makes all hiring legally suspect, and potentially dangerous. And so, thanks tot he fact that just doing business is potentially a violation of law, it creates circumstances ideal for everyone involved to try to cover themselves by finding ways to blame those above and below them.

What is interesting is that Americans, confronted with the fact that in Nazi Germany, and even before in the "free" Wiemar Republic, that pastors were employees of the state, are often shocked. They can't imagine giving the government control over religion, or making a religious figure an agent of the state. And yet, they have no problem doing the same to their doctor, their boss, they secretary, the clerk at their liquor store, or any of the hundreds of others with whom they interact daily. While we are rightly offended at the thought of government paid informers, and think it a gross violation of freedom, we have no problem when the government creates a host of amateur informers on the cheap through regulation.

And make no mistake, that is precisely what such regulation does. In case after case, government regulation creates situations where it is easier for an individual to side with the government against his employer, his coworkers, even his friends and family. It is just easier to pass the blame along and avoid all the headaches. And the government makes it easy, too. While they prosecute from time to time, in many cases, they simply ignore small violations. And so, for these amateur informers, passing the buck is even easier, as it is unlikely the one you denounce will be prosecuted. He will either pass the blame, or her will get a slap on the wrist. Of course, that is all good for the government, as they care more about information than prosecution for minor offenses. And so, by their supposed "leniency", they manage to make it easy, even ordinary, for us to become informers, to find ways to blame others so we can avoid blame ourselves.

And that, as the title of this posts says, is the harm I find in these regulations. Business, under an ideal government, would be a mutual, cooperative venture. Yes, there is competition, and that will always engender dissent. And there will be personal frictions. But, in general, trade and production are peaceful, cooperative ventures. It is only once we introduce the state that its influence warps such interactions, and turns us against each other as we try to avoid being the state's next sacrificial lamb.

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1. Actually, in an ideal world, while doctors would prescribe, such prescriptions would not be necessary ("Medical Regulations>" and "Medical Regulation II") and would be treated as simple recommendations, like "eat more vegetables" or "take an over the counter antacid", but as that creates problems for my analogy, let us ignore that for the moment and imagine our perfect world is only "almost perfect" and you still need prescriptions for medicine.

2. Before we begin, let me mention that the situation described does not apply to all opiates. For some reason, the government treats some opiates differently. Vicodin, and a few other weaker opiates, can be refilled over the phone. However, morphine, percocet/percodan, fentanyl, methadone and other stronger opiates require a face to face visit. Also, as far as I have discovered, there are very, very few doctors willing to risk writing them for longer than a month, and many who write them for even less time.

3. One other interesting aspect of this is that the government makes it impossible to take its own advice, as I mentioned before ("Right Hand? Pleased to Meet You! I'm Left Hand!"). Though the insurers have a role in this as well (refusing to fill prescriptions in advance) those willing to pay out of pocket could eventually work around that (though once they know you have insurance, some pharmacies get odd about paying out of pocket, especially for pain killers... again, thanks to the threat of government prosecution), the federal government has a far bigger role when it comes to pain medication. While recommending that for "disaster preparedness" we have medication available for a week to a month, they prevent the medical profession from writing prescriptions for extra medication. And so it is effectively impossible to follow government advice, thanks to the government.

4. There are additional changes to the doctor-patient relationship due to malpractice suits as well. While this too is the fault of the government, as they are responsible for the changes in how torts are handled, I won't get into those changes here. Not that it makes much difference. Effectively, the changes to tort law force a defensive "CYA" mindset on doctors, the same as other government interventions. And so, the effect of tort law changes are going to have the same effect as the more direct government involvement.

5. Doctors will argue this is because it requires giving less of the drug, but that is true of non-pain medications as well. Implanted distribution systems would work for many drugs, but seem to only be favored early in treatment for pain. Even diabetics, the other group receiving such pumps, tend to get them late in treatment, while doctors favor the pumps after the run out of other non-drug treatments, and the reason is almost entirely to avoid governmental headaches. (A suspicion confirmed by my current pain doctor, whose candor about the government and the amount of their intervention in his practice helped to confirm a lot of my suspicions.)

6. I know many disagree with my position on drug laws ("Drug Legalization", "Required Waste"), but even those who do have to confess that the argument is that we need to be protected from ourselves. And, as that is the case, then they must also accept the logical implications of their argument. For those, please see "Deadly Cynicism", "The Citizen Dichotomy", "In A Nutshell", "Cognitive Dissonance Part 2", "The Right Way", "The Danger Inherent in Banning "Bad Ideas"", "Contradictory World Views" and "Bad Economics Part 12".

7. My wife's hospital instituted as call-in line to allow nurses to report "errors" they observed in treatment. It was intended to keep track of such mistakes, and was supposed to be "non-punitive", but as nurses are disciplined for such errors, it obvious, and predictably, turned into an informer line allowing one nurse to turn in another, often for petty personal reasons. Similarly, in my former field of computer programming, and present field of administration, there is a fondness for "post mortem" and "lessons learned" meetings. They are meant to allow us to learn from past mistakes, but end up being nothing but opportunities to shift blame to someone else. As errors are not treated neutrally, it is inevitable that any meeting focuser on errors would turn into a chance to both avoid blame, and to redirect it upon professional or personal rivals. (See also "The Inevitability of Bureaucratic Management in Government Enterprises", "Bureaucracy Revisited ", "Organizations as Filters " and "Somewhat Off-Topic Rants".)

8. Yes, legitimate criminal laws can also generate such incentives, but we will deal with those later, as I think there is a large difference.

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POSTSCRIPT

Some may think my terminology over the top, but think about your job, especially if you are at a large firm. Ask yourself how many employees exist solely because of the government, or how many tasks exist just to appease the state. Look at your Human Resources department. It is almost completely dedicated to government-inspired tasks. Or think of the term "defensive medicine". Or think of all the cases where companies engage in actions to appease "the lawyers" or "the regulators" For that matter, ask yourself why in the popular media they venerate "whistle blowers", imagining that all who inform on their employers to the state are noble individuals persecuted by heartless bosses, rather than petty employees with a grudge. The state has managed to convince us that the highest good is to turn in others, and sadly we have gone along with them.

POSTSCRIPT II

As I said in "Hiatus", I am officially on vacation. However, as always, I cannot seem to avoid writing entirely. (In addition to this post, I may also post an article about assisted suicide on which I was working earlier.) Perhaps it is because there is little else to do when work is slow, I don't know. Whatever the case, this doe snot mean I am no longer on vacation. I am still taking a few days off, I just could not resist writing completely.