- The Washington Times - Monday, April 9, 2007

Bing Spear introduced Ann Dally to me in glowing terms: She was a sensible London doctor who saw the need to treat addicts on an individualized basis and not in line with the dominant rigid drug-clinic approach.

The professional relationship between Bing and Ann had a uniquely British aura to it. Bing was the distinguished H.B. Spear, chief inspector, Drugs Branch, Home Office; the doyen of official drug experts in the United Kingdom.

Ann was a psychiatrist in a high-toned London practice that included royalty, nobility and city bankers among its clientele. Suddenly, she somehow found herself with a number of drug addicts of a range of social classes among her patients. As was her custom regarding a new type of case, she went to the medical literature for guidance on how to treat drug addicts.

Even though the British system of drug control and treatment was, and is to this day, one of the best in the world, nevertheless there is no consistent scientific basis holding it together. That is a shocking, dirty medical professional secret that is not supposed to be mentioned in front of the children or in polite adult company over dinner. Let me state it another way: There is no scientific basis for the choice of any method for the treatment of drug addicts in any country, anywhere, ever in history. Science is involved but does not dominate the process. Ann discovered this soon after reading the major pieces of medical literature on the subject, terming most of it “gobbledygook.”

She then started treating her addicted patients as she treated the others, based upon her own clinical judgment after extensive interviews of each person. By the late 1970s, numerous addicts had been repelled by the impersonal, rigid rules setting limits on the use of injectable drugs, on the amount, and so on that had been applied in many of the vaunted London clinics. She adopted a number of flexible modalities that seemed to help her patients and which could serve as a model for treatment in the United Kingdom and here. This involved the prescription of powerful narcotics, including injectable methadone, on a long-term basis in appropriate dosages. She never prescribed heroin because she did not have the required license. Of course, no American doctor can prescribe any injectable drug to an addict. Moreover, while heroin is available for pain control and addiction treatment in the United Kingdom, it is totally forbidden in the United States.

Thus was this American wandering scholar confronted with a situation where the leading drug official of the country had happily introduced me to a doctor who treated about 150 addicted patients in part by prescribing injectable drugs to them. Moreover, that official observed that Ann’s methods of clean, prescribed drugs plus emotional support and guidance were assisting these potential derelicts to lead legal lives, away from the black market.

The ideal of helping an addict lead a fairly normal life on drugs, but not without them, was expressed in the historic Rolleston Report of 1926. Bing Spear saw himself as the latter-day custodian of that wonderful report and he also believed that Ann Dally was living up to its humane spirit. He was quite open for years in his support of Ann and also open in his criticism of the “London Mafia,” as he called the group of doctors (including, among others, Thomas Bewley and Philip Connell) who ran the London clinics and who dominated the medical profession’s approach to drug treatment.

At the end of the day, the “Mafia” docs won. Ann committed a number of “felonies” in their eyes. She was an uppity female. She was a medical journalist who wrote for the popular press and appeared in the electronic media fluently expressing her dissenting views, which were often dismissive of those of her professional betters. She was a “private” doctor practicing outside of the National Health Service, and, horrors of British horrors, charged fees for her professional services, but not for each prescription, as was often implied.

Starting in the early eighties, Ann was dragged before a series of medical committees and charged with “serious professional misconduct” and related medical offenses. I observed a number of these professional witch trials and assisted in her defense over the years, including an appearance in one of them as an expert witness. The trials demonstrated just how much good Ann was doing for her patients. They proved once again that styles in medical treatment are based upon professional hunches and personal judgments. One medical “school” of clinical judgment proceeds to destroy the career of the practitioner of another school, as has happened for decades in the United States and is now happening in the United Kingdom.

Unlike American doctors such as William Hurwitz who face criminal convictions and prison time, Ann Dally was never charged with a crime. However, she was banned from prescribing controlled drugs, and by the late eighties, exhausted by the mindless charges, withdrew from practice. H.B. Spear had left his post in 1986 and died at age 67 in 1995. Ann Dally just passed away at the age of 80.

Today, professional schizophrenia reigns on the United Kingdom drug scene. The NHS drug clinics continue in their rigid course, but a few have adopted a wide range of flexible, experimental practices that would have delighted Bing and Ann. Some private addiction treatment doctors the latest being Colin Brewer still get hauled before the medical heresy courts and defrocked. It remains a disorderly, confusing situation, but still a country mile better than the situation here in the belly of the prohibition beast and the war on drugs.

Arnold Trebach, professor emeritus at American University, is the author of “The Heroin Solution.”

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