How Good Is E.R.'s Rx?

By LEON JAROFF

Most TV viewers tune in to medical dramas like E.R. and Chicago Hope for the drama, not the medicine. But it's hard not to pick up a little medical lore along the way. Take the final episode of E.R., for example, in which George Clooney, in his role as Dr. Doug Ross, faced censure for his unauthorized use of a procedure called ultrarapid opiate detoxification on a tiny patient--an infant born to a heroin-addicted mother. After a harrowing all-night vigil, during which the infant hovered near death, the detoxification was a success and the baby drug-free. Grateful and overjoyed, the mother pleaded with Doug, "Can you do it to me?"

The message taken home by millions of E.R. viewers is that ultra-rapid detox is a shortcut to drug withdrawal. And that's a problem, say many doctors. They fear it will result in a stampede of new patients to the controversial and still experimental procedure. Ultrarapid detox, they charge, has not been adequately studied and is often promoted by medical entrepreneurs who make exaggerated claims and operate out of hotel rooms and storefronts.

Of greater concern, a report released two years ago by the National Institute on Drug Abuse warned that the technique involves an "unacceptable" risk of death, and a review article in the Journal of the American Medical Association last January concluded that existing data do not support the safety of the process and that more study is needed to determine its efficacy. Says Dr. Thomas Kosten, of Yale University School of Medicine, who co-authored the journal review: "It's like using a cruise missile when all you need is a hatchet. It's overkill. Opiate detox is not that hard to accomplish." In May 1997 the British Medical Journal reported that a patient had died while undergoing the procedure.

Addicts who can afford ultrarapid detox--the procedure costs as much as $10,000--are attracted to it because they can escape days and even weeks of agonizing withdrawal symptoms. They are given an antagonist, usually naltrexone or naloxone, that quickly displaces opiates and attaches itself to the same brain receptors that opiates seek out. During the several hours of detoxification, patients are under general anesthesia and unaware of the severe "shake and bake" symptoms they are enduring. Still, they are often dizzy, exhausted and barely able to walk after awakening. And they need the same follow-up counseling and treatment as conventionally detoxed addicts to keep them from slipping back into their old habits.

The largest purveyor of rapid detox is the Center for the Investigation and Treatment of Addiction, which pioneered the technique and opened its first clinic in Israel in 1993. It has since expanded and changed hands several times, franchising clinics in several countries and treating thousands of addicts--to a drumbeat of criticism. The British medical journal Lancet, for one, has blasted CITA for exploiting "the hopes and fears of opioid addicts and their families [and] for making exaggerated claims."

CITA currently has four clinics in the U.S., all of which are affiliated with major hospitals, and charges $6,800 per treatment. But it is not the only game in town. Storefront clinics, using variations of CITA's patented procedure, have sprung up across the nation, and a California entrepreneur is selling franchises for at-home detox centers for $1,000 apiece.

It is these treatment boutiques and the businessmen who are promoting them that have given rapid detox a bad name, says Dr. Ron Wender, head of anesthesiology at Cedars-Sinai Medical Center in Los Angeles. Wender's experience at the CITA center at Cedars-Sinai has convinced him that ultrarapid detox, properly performed and with appropriate follow-up, "should be welcomed with open arms."

What prompted E.R.'s producers to air the ultrarapid detox drama? Critics point to an April article in the Wall Street Journal that detailed instances of TV shows being successfully lobbied by medical foundations and others to include dramatizations of specific diseases. In one example the Journal described how the Henry J. Kaiser Family Foundation wooed Dr. Neal Baer, an E.R. writer and producer, besieging him with studies on the increased risk of contracting AIDS for those with chlamydia, a sexually transmitted disease--a risk that was then mentioned on E.R.

Baer denies that he was lobbied to put either chlamydia or rapid-detox on E.R. Chlamydia is a common problem and so, in Hollywood, is heroin addiction; one marquee actor is reported to have gone through ultrarapid detox just in time for this year's Academy Awards. In fact, says Baer, the idea for the detox episode came from a pediatric anesthesiologist invited by E.R. to help generate story lines.

That still leaves other questions on the minds of E.R. fans. Has Doug's impulsive act jeopardized his career? Is he still on staff? Is he still the sexiest man alive? Tune in next September.

--Reported by Edward Barnes/New York and Jeanne McDowell/Los Angeles

With reporting by Edward Barnes/New York and Jeanne McDowell/Los Angeles