Shrinkette's rant about a "Heinous, deplorable, contemptible NYT article" touched off quite a lively discussion.

First, let's be clear that she has a point. The "sharing meds, selling meds, prescribing meds, and donating meds" would likely be illegal under the controlled substances laws. Whether or not these laws should be in place. Yes, the health risks are nothing to be dismissive about. Yes there is danger of side-effects, addiction and withdrawal, drug interactions, organ damage and other bad stuff.

Certainly the NYT article should not be encouraging drug trading behavior. But let us set aside the emotions and ask why this is happening. Feel free to add to our short list of likely reasons:

1. Patients do not understand the dangers
2. They understand but choose to ignore them
3. They do not trust the quality of our health system

Enough was said about first two reasons. Let's examine the last one.

Shrinkette says that "A doctor with intensive training can have trouble with these meds...and these patients are going to do better on their own?". Sounds like admission that doctors are not infallible. Institute of Medicine report shows that the number of deaths due to preventable medical errors is around 100,000 annually. A preventable error means that a doctor or a pharmacist or another healthcare professional did something wrong that could be avoided.

Most healthcare professionals mean well, but:

• How much of physician's time does a patient get?
• Does every doctor really have the complete medical record from all relevant sources to make the right decisions?
• Does our medical science have unambiguous answers for every question?
• Do doctors suffer results of medical mistakes on their own health?
• Does our health system reward quality or volume?

We should not be blaming the patients and New York Times for failings of our health system, still stuck with 19th century processes. As Newt Gingrich so eloquently put it, if airlines were like healthcare, we would have hundreds of people dying in a plane crash every day, pilots would not be hurt and nobody would care.

We need a care model where patients and physicians treat each other as partners, medical decisions are supported by lifetime electronic health record and evidence-based guidelines, and where financial rewards are based on outcomes.

Who would disagree with that?