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Pain Doctor's Trial: Pain Experts Disagree

<lst>Dr. Michael Ashburn studied several thousand medical charts of William E. Hurwitz’s patients for the prosecution in preparation to serve as an expert witness.

"I saw very little evidence that Dr. Hurwitz was carefully monitoring his patients," Ashburn testified. "I have no reason to believe he knew the patients based on the quality of care he provided."

In almost every case he testified about, he told the jury that Hurwitz's prescriptions were "outside the bounds of medicine and served no legitimate medical purpose."

On cross-examination by Hurwitz's attorney Patrick Hallinan, Ashburn admitted that he charged the U.S. government $200 per hour, approximately $40,000 to $50,000 overall for his work preparing for testimony. Ashburn, a professor of anesthesiology at the University of Utah, also founded a company that is developing high-dose drug delivery systems to treat chronic pain.

Ashburn said that his company ZARS has been developing a pain patch that can be applied to the skin. The product, which will compete on the market with opioids like OxyContin, is expected to be 100 times more potent than morphine.

Ashburn's testimony in Hurwitz's trial has already caused "profound concern" in the medical community, according to Dr. Russell K. Portenoy, chairman of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York. Portenoy wrote a letter stating that much of Ashburn's statements are "factually wrong" or "serious misstatements of consensus in the field."

"We are deeply concerned that serious misrepresentations in the testimony provided by the government's expert, Dr. Michael Ashburn, will undermine the welfare of patients who suffer in chronic pain," wrote Portenoy, past-president of the American Pain Society, in a Dec. 10 letter to Hurwitz's attorney, Marvin Miller.

"Dr. Ashburn implies that opioid treatment of a patient with known addiction is medically wrong and worsens the addiction. That is not the view of experienced clinicians in the field. It is unacceptable to promulgate the view that the disease of addiction automatically denies patients with severe pain the possibility of relief through careful opioid therapy," Portenoy wrote.

The jury specifically asked Senior Judge Leonard D. Wexler if prescribing opioids to an addicted patient was illegal.

"Whether the physician thinks, suspects or knows that the patient is addicted to illicit drugs is a circumstance you may consider in determining whether the prescription of opioids to that patient is not for a legitimate medical purpose or beyond the bounds of medical practice," read a portion of Judge Wexler's response.

Miller filed a motion on Monday, Dec. 13 for charges against Hurwitz to be dismissed, attaching Portenoy's letter in support.

Dr. Scott Fishman, chief of the division of Pain Medicine at the University of California, agreed with Portenoy.

"I believe that Dr. Ashburn's comments do not represent a consensus opinion of pain specialists. In my opinion, his views are inconsistent with mainstream views of most leaders in the medical discipline on pain medicine," according to Fishman.