I believe there was a time when the doctor and patient worked together to decide on a course of action. Perhaps I am naïve, in that belief.
Today, I can only speculate on the forces operating on my doctor. He may be influenced by hidden (or overt) kick-backs from the pharmaceutical companies. Maybe with a certain number of prescriptions, they will send him to a conference in the Bahamas.
Of course, my doctor operates with the oversight of the insurance companies. Their decision to pay, refuse to pay, or pay to varying degrees, for procedures or medications, will often decide treatment.
My doctor also operates at legal risk. For example my wife’s cardiologist must not only prescribe statins, but must prescribe a certain dose, to stay within guidelines, a form of lawsuit insurance.
Doctors who do not toe the AMA guidelines on a multitude of topics, can lose their certification. That would be bad enough in itself, but it also contains legal implications.
So when you talk to your Doctor, who is whispering in his ear?
You don’t know anything about pain management do you?
It’s not like that whatsoever
That's the way the doctor-patient is supposed to be. You have mentioned pressure. Make no mistake: there is pressure coming from all sides, not just the pharmaceutical lobby.
However anyone may wish otherwise, the DEA is a Tyrannical abomination, and it is driving many of the forces which are causing heroin and other street drugs to become so widely used, with the predictable consequences, as people get squeezed out of the "legal" channels for "managing their pain".
The doctor-patient relationship is sacrosanct. Decisions regarding treatment and medication should begin there, and end there—not with the DEA, not with the pharmacist, and not with the insurance companies.
And there shouldn't be two tiers of service and liability: one for the affluent and connected—people like Rush Limbaugh, for instance—and another for the middle class and those who face the full Tyrannical weight of Contraband Law.
I'd rather there be higher levels of dependence and addiction than having people OD'ing on street drugs of unknown strength, or facing 10 year minimum mandatory sentences for having the wrong medication in their pocket.
With respect to pharmaceuticals, a person has to make a serious effort to end up dead, because the strengths are precisely known. In my 52 years, everyone I know of who has ended up dead from an OD has done so because of street drugs—not pharmaceuticals.
In a free society—with all of its inconvenient challenges—education and rehabilitation are the answers to this societal woe—not Prohibition and draconian threats of incarceration. We've seen how that worked with the worst drug on the face of the earth—alcohol—whose evils exceed those of all other drugs combined when considered fully.
So it's not about supply—it's about demand. If someone wants to sit at home in a stupor and drool on themselves due to alcohol, opiates, or benzodiazepines, let them. They are responsible for their own actions, and their families and health care providers can worry about the rest. Thugs with automatic rifles and no-knock warrants don't belong in the equation...