At a hearing this week in Bethesda, Md., on reducing fatal prescription overdoses, a federal panel heard from an East Bay man identified as a “clinician” that the real problem was that some doctors weren’t prescribing enough drugs.
Trouble was, Edward Manougian was not a clinician— not any more.
He lost his California medical license over the very practices on which he lectured the panel of U.S. Food & Drug Administration officials.
The 83-year-old Berkeley man pointed with a yardstick to a hand-drawn diagram sketching his theory on the “pathophysiology of pain.” Some patients require high doses of powerful painkillers known as opioids, he said. He faulted doctors who fail to “treat them correctly”--forcing patients to turn to emergency rooms and the streets for drugs.
Many opioid overdoses, he said, were caused by "patients not getting the right dose and having to get drugs off the street.”
His testimony, submitted via videotape for the hearing that ended Friday, was webcast live by the agency. The FDA does not screen people who request to speak at public hearings and allows them to identify themselves, a spokeswoman said.
Manougian did not say that the Medical Board of California had revoked his license in October after finding that the combinations and doses of drugs he ordered for several patients were dangerous and demonstrated gross negligence.
Two of his patients in their 30s fatally overdosed on painkillers after he gave them prescriptions for the same type of drugs, Medical Board records show.
Manougian asserted in his defense to the state board that he was following his “pathophysiology of pain” theory, the same one that he presented to the FDA. A medical board expert called the theory "supposition" and said that "it does not represent any of the current science or knowledge of chronic pain."
In recommending license revocation, Administrative Law Judge Mary-Margaret Anderson said drugs prescribed by Manougian have ended up on the street.
“With blinders firmly in place," she wrote, "he conducted his practice in accordance with his own idiosyncratic views and methods, in disregard of the safety of his patients and the public health."
In an interview Friday, Manougian maintained that his care was appropriate. He has filed an appeal in an attempt to win his license back.
For now, though, Manougian is barred from practicing medicine or calling himself a doctor in California, said Lynda Gledhill, a spokeswoman for the state attorney general’s office.
In December, two months after he lost his license, Manougian said he registered to testify at the FDA hearing as "a physician, a clinician."
"I'm a doctor, and my license has not really ended yet," he said, because his case is on appeal. "I'm a clinician. I'm just not an active clinician."
Marvin Firestone, a physician and Manougian's lawyer, said he "certainly couldn't put himself out as a physician with an unrestricted license at this time." He added: "Probably the correct thing to say is, 'I have been a clinician for 55 years,' putting it in the past tense."
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