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You would think Bob Cummins would have had the most attentive health care as he neared the end of his battle with prostate cancer. The former lawyer was being treated in two of the best hospitals in New York City. He wasn't fabulously wealthy; he had devoted most of his time to producing jazz records, which aren't big moneymakers. But at age 69, Cummins had a nest egg.
Many cancer patients experience horrible pain near death, and even the best oncologists don't always know how to ease it. "I got the usual--'Load 'em with codeine'--and I couldn't focus across the room," Cummins recalled. The drugs sapped his will to do anything but stare at Knicks games. A friend who also has cancer phoned one day to ask if he had tried any new treatments. No. "It hit me," Cummins said later, weeping at the memory. "I had just given up."
He sought out a pain specialist and eventually found the department of pain medicine and palliative care at Beth Israel Medical Center in Manhattan, one of only a handful of such facilities in the U.S. Dr. Lauren Shaiova prescribed fentanyl, a stronger pain medication that made Cummins comfortable but not cloudy. Finally, his agony and fog lifted. "We call her our angel," said Nancy, Bob's wife, of Shaiova. But she was only practicing basic pain management, using readily available drugs. "Most docs just say, 'There's nothing more we can do,'" laments Shaiova. "I tell them, 'I can actively treat your pain.'"
Many doctors flinch at using controlled substances because of the nation's harsh antidrug laws. A 1998 survey of New York State physicians found that 71% chose a drug that did not require a triplicate form--necessary for dispensing many controlled substances such as fentanyl--even when the controlled drug was the appropriate treatment. Instead they regularly choose weaker medications because they fear legal scrutiny.
Many physicians are also erroneously worried that they will addict patients or even kill them. Last year Kathleen Foley, another New York City pain specialist, released a study showing that 40% of her fellow neurologists wrongly believed that using a dose of morphine big enough to control breathlessness would actually euthanize the patient. (In truth, there's no ceiling dose of morphine, as long as the patient is given time to adjust.)
Barbara Strong, 59, suffered because of such ignorance. Miami doctors refused the former nurse's pleas for medication when horrific cancer pain struck. After Strong rebelled and found a pain specialist, her regular doctor "went wacko...He said I would become addicted." So Strong stayed with the oncologist; eventually her pain got so awful she could barely move. "I wanted to be dead," she says. As a Christian, Strong couldn't go through with actually killing herself, but she did consider an alternative: "Jack Kevorkian, where are you?"
Instead, Strong dumped her doctor and called Dr. Pamela Sutton, the specialist who had helped her before. Soon she was back on the golf course. She could play until recently, when her condition slid. "I wouldn't be alive today if not for Pam Sutton," she says. Strong is fortunate to have sought help. Many don't, for a misguided reason: 82% of respondents in one study agreed with a pollster that "it is easy to become too reliant on pain medication." In fact, fewer than 1% of those treated with opioids become addicted.