Dr. Lance Gooberman can't believe what he sees. Stopping just inside the open doorway of his attorney's conference room to hike up his pants and his courage, he guesses there must be at least three TV crews and a dozen photographers and newspaper reporters. For most of the past four and a half years, he reminds himself, the media has been loving him, especially the television people. Many of them reported on his "rapid opiate detox" as a breakthrough alternative for junkies wanting to get clean. And so what if Geraldo Rivera isn't Dan Rather? He still credited Gooberman on national TV with inventing "a magic bullet" to fight heroin addiction.
But now that New Jersey state officials are coming down on him with a sledgehammer, Gooberman hopes this press conference will rally media support and make junkies aware they are losing what he considers a proven jump-start to getting straight.
At a time when thousands of heroin addicts need his services, he can't understand why the state's attorney general just forced him to stop performing ROD, or why the New Jersey board of medical examiners wants to revoke his license.
The 48-year-old doctor, a short, muscular man with pale, freckled skin, a red beard and receding red hair, feels the droplets of sweat beading on his forehead. The anxiety pangs rabbit-punching his gut now are nothing compared to the hell he experienced during that insane period years ago, when he almost lost everything, including his life. I'm still better off today, no matter what, Gooberman keeps telling himself.
Hands and voice trembling, he reads his statement: He's treated more than 2,000 patients with rapid opiate detox. … Other physicians are performing the procedure. … He dreams of the day when ROD is available throughout the tri-state area. … Last week's newspaper reported that in 1996, heroin caused 60 percent of all overdose deaths in the eight-county Philadelphia region … and ROD seems to be one of the country's best shots at stopping heroin-related deaths.
To personify the power of heroin and his success in fighting it, Gooberman introduces 50-year-old Richard and 20-year-old Stephanie. Richard is a tall, tanned laborer from Wildwood, and Stephanie, clad in black, with ornate rings on every finger, lives in Philadelphia.
Richard says that before visiting Gooberman's clinic, he had been addicted to heroin for 30 years. "I went through his procedure … and went home. I felt a little sick for a few hours, but nothing like before, when I tried to detox myself. I can say that from then on my life has changed. … My family is talking with me instead of hiding stuff from me. I'm not a crook. I'm working steady. Saving money. Pay my own bills."
Richard then reaches for the box of tissues in front of him; when he dabs his eyes, the flashbulbs pop, pop, pop, followed by the sound of advancing film.
They're getting it, Gooberman tells himself. They're getting it.
"I thought," Richard says, "I was going to die on drugs."
Stephanie says she started on heroin when she was 15 and that to support her habit, "I had to become, like, a prostitute and all that." She got kicked out of school, got locked up. Like Richard, she tried other ways to get off smack. Finally, 10 months ago, she went to Gooberman for ROD, and she says she has stayed clean since. "I just want to say thanks to Dr. Gooberman," she announces. "Because if it wasn't for him, I don't know where I'd be right now."
Then the reporters' questions come. They all want to know more about the six Gooberman patients who died shortly after having ROD.
Gooberman turns briefly to exhale his disgust. Jesus, he wonders, weren't they listening to Richard and Stephanie? Doesn't anyone get it?
He wants to jump up and scream that he never gambled with his patients' lives. He gave all 2,000-plus of them excellent care, dammit! Including the ones who died.
But Gooberman behaves like the calm, quiet client his lawyer has begged him to be. His few responses are measured and emotionless.
He'll work through the stress at his next 12-step meeting.
It's a Sunday morning in November, weeks after his press conference, and Gooberman has brought me to a meeting of recovering addicts in South Jersey.
His Lexus sedan isn't the only car of its kind in the parking lot, but it is the only one with a license plate reading DTX DOC. The heroin addicts in attendance include several middle- to-upper-class fathers and mothers, a former famous r&b singer, a local politico, and a clean-cut gray-haired man wearing tan corduroys and a maroon ALASKA sweatshirt.
When the floor is opened, the gray-haired man says he has spent the past three days sleeping in a bus station. "I haven't seen my family, I haven't seen my grandchildren, in days," he says. Then he cries, literally cries, for help.
When the man finishes, a few people jot down their phone numbers on a piece of paper for him, while the rest of the room claps to show support. There are tears and shouts: "It's okay, man." "You can make it." "We've all been there, brother."
The detox doc is clapping, too. "It's all right, man," he says, almost as much to himself as to the newcomer.
Ever since the attorney general's office and the medical board accused him of "gross and repeated malpractice, negligence and incompetence," Gooberman says, he's been attending about seven meetings a week. Usually he comes to "get spiritual," but today he is here to provide a glimpse of what it's like to be a junkie; to show me how desperate addicts are to exorcise the chemical evil from their bodies, for their own sake and for their families; to show me what he went through and why he believes his controversial procedure is necessary.
Gooberman grew up the eldest of four kids-he has two brothers, a chiropractor and a pediatrician, and a sister-in Pennsauken, New Jersey. His father, Herbert, drove a truck, delivering bread and snacks to mom-and-pop stores around South Jersey; his mother, Bernice, worked as a secretary at American Honda. Herbert and Bernice were loving, religious working-class parents who provided their children with a solid, stable home life.
Yet at Pennsauken High, as Gooberman was taking his first steps toward becoming a doctor-by working as an orderly and meeting his future wife, Marcia Olsson, in Spanish class-he was also beginning a long, destructive affair with drugs. In order to lose weight for the wrestling team, Gooberman started dipping into his father's amphetamine prescription. "I dropped from wrestling in the 136-pound weight class to wrestling at 106 pounds," he says. "I was throwing guys all over the mat."
Throughout high school, everyone knew Gooberman wanted to be a doctor-his nickname was "Doc"-so it was no surprise that he went off to college planning to major in premed. He says he made the dean's list his freshman year at Ohio's Findlay College, but he missed Marcia, his high-school sweetheart, then at Rutgers. Gooberman came home and got jobs working on an ambulance crew and as an orderly in the E.R. at Cherry Hill Hospital (now Kennedy Hospital). He was still using amphetamines and now smoking a lot of pot.
In 1972, two years after graduating from high school, he and Marcia got married. Marcia wasn't sure what she wanted to do with her life, and her husband, still interested in all things medical, convinced her to go to radiology school. A year later, Marcia wanted to be a doctor as much as Gooberman did. In retrospect, Marcia, now Dr. Marcia Mastrin, a general practitioner in Cherry Hill, says Gooberman's urging her to go into medicine "was one of the good things about the relationship." Together, the pair enrolled in Camden County Community College and took premed courses.
They were B-plus students, which they knew wasn't going to get them into American medical schools. Around that time, however, Gooberman met some medical students from Mexico who were interning at Cherry Hill Hospital. The Mexicans suggested he and his wife head south of the border.
They enrolled in a private med school in Guadalajara for one year, then transferred to the University of Ciudad Juãrez. Gooberman's mother, Marcia says, paid their tuitions. To get through med school, Gooberman continued to depend on the amphetamines that had helped him win wrestling matches.
After graduating in 1978, the couple returned to the States and moved to Wilmington, Delaware, so Gooberman could intern at Wilmington Medical Center. Now that he was working in a hospital, he says, he stopped doing drugs. He wouldn't remain clean and sober for long.
In 1980, just as Gooberman was starting his residency at Camden's Cooper Medical Hospital, his marriage began to fall apart. Although Marcia now says, "Lance and I were always two very different people," she adds that things got really bad because her husband was always at the hospital, and she felt left behind. Gooberman says the relationship collapsed when his wife, four months pregnant, told him she'd been having an affair. Marcia denies ever having the affair.
Gooberman maintains that the day after he learned of the alleged infidelity, he turned to alcohol. He boozed hard for the next three years, and says he then began "fooling around" with women. After he finished his residency, the new M.D. and his unhappy family moved to Cherry Hill, and he established a private practice in Merchantville. He became one of the first doctors in South Jersey to sign on with U.S. Healthcare, which fueled an incredibly successful practice. But Gooberman's marriage was failing fast. Neither Marcia nor he can remember whether their worsening relationship led him to use more serious drugs, or vice versa.
The young doctor resumed taking amphetamines on a daily basis and also started shooting Valium and free-basing cocaine. He had a wide variety of pipes in his bedroom. He quickly stopped free-basing, though, because it was making him impotent. (By this time, both Gooberman and his wife had developed separate, steady relationships.) "I didn't think I had a drug problem," he says now, "because I was showing up for work every day. And of course, I could see 80 patients a day and go make my rounds at the hospital at 2 a.m., because I wasn't sleeping."
Then the doc started to lose it. One night in 1986, Gooberman, totally high, with who knows what drugs and distorted emotions surging through his veins, got into an argument with Marcia and ripped a door off its hinges. Shortly thereafter, Marcia obtained a restraining order and filed for divorce. Gooberman, stoned behind the wheel of his sports car, hit an icy patch and smashed into a guardrail near Cuthbert Boulevard, not far from his office. "I remember the trooper-his name was Frank, he was one of my patients-asking me, 'Are you okay?'" Gooberman says. "I said, 'Yeah, but where's my car?' He said, 'You're sitting in it.'"
Gooberman decided it was time to get clean. He borrowed the key to a friend's house in Jacksonville, Florida, and hopped on a plane. He says he took bags "filled with all kinds of drugs," including adrenaline-"figuring if I couldn't detox myself, there'd be enough in there to kill myself." He almost accomplished that.
He spent days, maybe weeks, in Florida-he was so whacked that he doesn't remember how long he was there, shooting up "all kinds of stuff." He even skin-popped the adrenaline-but instead of killing him, it gave him a buzz. He shot himself up until, he says, "I couldn't hit veins anymore. My fingers were like sausages, because the Valium was blowing the veins." He got on a plane and flew to a friend's place in El Paso. The friend took Gooberman to a hospital. "Somehow it was agreed upon," Gooberman says, "that I would fly back here to Philadelphia and get help. The [doctors] said if I would get on the plane and go back, they would give me any [drugs] I wanted."
Because Gooberman's veins had virtually disappeared, the treating physician installed a heparin lock-an IV hookup that goes directly into a vein-so he could self-medicate on the plane ride home. In the air, Gooberman went into the bathroom every 10 minutes and took more drugs. "Not to get high. I was trying to stop the itching. The itching was un-fucking-believable," he says of the side effect of his binge.
A doctor friend met Gooberman at the airport and took him to the Institute at Pennsylvania Hospital the next day. He was transferred to the E.R. and hooked up to a heart monitor. Gooberman heard an arrhythmia on the machine and asked who else was plugged in. "Nobody," said his doctor friend. Gooberman knew he was in trouble.
"I was in the Poconos with my friend and her daughter and my son when I got the call," says Marcia. "But by then, I didn't care. … I was the one who held the practice together while he was off wherever he was. Some nights, I had to choose between eating or sleeping. No, by then I didn't care about him."
At the hospital, Gooberman asked the attending physician who was going to take care of him: A cardiologist for the arrhythmia? A hematologist for his blood that wasn't clotting? A dermatologist for the itching? "No," the doctor informed him. "A general internist."
"Bullshit," Gooberman said. "I am a general internist. I'm a great one, and I don't know what the hell to do for me."
"We're going to have a sober internist look at you," the doctor responded.
Gooberman was admitted to a psychiatric unit for a few days, put on antipsychotic medication, and transferred to a psychiatric hospital. He stayed for 42 days before leaving in April 1987.
"I remember when I was sitting in that psychiatric hospital, all I wanted was for the itching to stop," Gooberman says.
We're sitting in the den of his contemporary colonial home on a picture-perfect tree-lined street in Haddonfield. On the way in, Gooberman gave me a tour, pointing out decorative touches like the collection of decoy ducks on the mantle and the brass brackets adorning the wall. "She thinks of this stuff," Gooberman says proudly, referring to his second wife, Barbara Smith, whom he met through friends in 1992; they married a year and a half later.
At the moment, Barbara Smith, a former CPA pursuing her MBA at Drexel, is in the kitchen, making blueberry and chocolate-chip pancakes for her teenage son and his friends. Smith, divorced and with three children of her own, exudes maternal warmth and sincerity; she's the kind of woman who makes Gooberman feel he can't be all bad if she loves him.
The conversation we are having, in this setting, seems like a drug-induced trip itself. "The itching," Gooberman says again, scratching his thick forearms. "You have no idea what that's like. When you're in a position like that, let me tell you-money is not important; relationships are not important. Nothing means anything, because you can't escape your skin."
After he left the psychiatric hospital, Gooberman took about six months off. He went to N.A. meetings, and he got a sponsor. As soon as he regained reading comprehension, Gooberman says, he immersed himself in addiction-treatment literature and attended conferences conducted by the American Society of Addiction Medicine. He wanted to learn all he could about the disease that had gotten under his skin.
He took ASAM courses and eventually passed the exam to become an ASAM member. When he resumed practicing medicine, he spotted cases of drug addiction all around him. He started seeing the symptoms in the primary-care patients who would came to his office in the morning and in some of his afternoon consults at local hospitals. In time, he says, he got quite good at taking care of drug addicts, particularly at detoxifying them. But he felt hospitals weren't doing very well with opiate addicts.
"Number one, they wouldn't come into the hospital, because they were afraid of the discomfort," he says. "Number two, they didn't hang around when they did come in, because we couldn't keep them comfortable. And number three, they'd relapse right after they left."
Then an ASAM member told Gooberman about a procedure he had seen in Austria, called rapid opiate detox. As the name boldly states, rapid opiate detox-sometimes called "ultra-rapid opiate detox"-quickly flushes opiates found in heroin out of an addict's system. While an "opiate" is defined as a narcotic derived from opium, there are natural opiates in the body, called "endorphins." Both endorphins and the opiates in heroin are "agonists," meaning they lock onto and stimulate brain receptors that send "pleasant" charges-the sort of euphoric sensations you experience during sex, or when eating chocolate. Heroin induces a bliss far surpassing anything natural stimulants can deliver.
The difference, of course, is that endorphins don't wreak havoc on the body's precarious chemistry, or cause brain damage, fatal cardiac arrest or respiratory problems, the way heroin can.
Once heroin establishes a new chemical equilibrium in the body, living without it is unbearable. During the initial phase of natural opiate withdrawal-quitting cold turkey-the addict is overwhelmed by flu-like symptoms: sweating, nausea, vomiting, diarrhea, fever, and sometimes a relentless itching. These frequently drive an addict to abandon detox.
In the 1950s, researchers developed methadone withdrawal. In this alternative, still used today, a doctor substitutes the less addictive synthetic narcotic for heroin and then slowly decreases the dosage to avoid the painful withdrawal symptoms. Methadone doesn't create a high, but it does suppress the craving for heroin. Unfortunately, methadone treatment has a high relapse rate and tends to morph into a program of "methadone maintenance." Critics say this merely trades one addiction for another at taxpayers' expense.
In the 1980s, Yale researchers found that if they injected patients with certain "opiate antagonists," they could induce rapid and brief withdrawal. The drug naltrexone stripped heroin from the receptors immediately and suppressed the craving for it for hours.
A few years later, in 1988, Austrian Dr. Neil Loimer made the Yale rapid opiate detox method much more speedy and comfortable by inducing the procedure while the addict was under a general anesthetic. (Ironically, this technique was a throwback to a "hibernation therapy" of the 1940s, which kept the patient asleep for one to three days.)
Gooberman read literature and consulted with addiction specialists on this new technique. Eventually, he tried to find a hospital that would allow him to try the procedure. West Jersey Hospital said no; Cooper Medical Center in Camden said yes. Gooberman began performing RODs in the intermediate intensive care unit at Cooper Medical Center.
Dr. Carolyn Bekes, who headed the critical units at the time and gave Gooberman permission to conduct the new detox approach, remembers that he performed about 25 RODs, trouble-free, in the year he was there. Medicaid paid the per-patient cost of $3,200. Although ROD took only a few hours, Medicaid lumped all detoxes into one rate category based on a five-day stay. Of the $3,200, Gooberman was paid only about $32. That was not, however, why Gooberman left Cooper and began doing RODs at his primary-care office, according to Bekes. She says he was simply finding it hard to get the hospital to admit his patients, who didn't technically qualify as emergencies, for the procedure. Cooper needed the beds.
With little published information on ROD, the FDA wouldn't approve it. But Gooberman wasn't violating any medical codes of conduct per se. A medical license gives physicians the right to do anything in their offices as long as they don't break any laws or put their patients "at undue risk." That latter phrase leaves wide room for interpretation.
By 1995, the two or three RODs Gooberman performed at his Merchantville office each weekend commanded more time and office space. Gooberman says he had junkies begging for help.
In those first few months, he saw firsthand the problem with oral naltrexone. A traditional naltrexone pill only blocks the effects of heroin for 24 to 48 hours. To go on neutralizing the drug, an addict must follow a strict dosage schedule. Many junkies simply stop taking the pills and relapse.
Gooberman considered the birth control drug Norplant, which is inserted under the skin and released into the blood over time. He consulted with an in-vitro fertilization specialist, talked to a pharmacist-and a new approach was born. Gooberman created a thimble-size "pellet," containing one full gram of naltrexone, which he inserted under the patient's skin. The pellet slowly dissolved into the bloodstream for up to 30 days. Much to his wife's chagrin, Gooberman used himself as his first test patient.
Inserting a new pellet when the first one wore off became an adjunct Gooberman business-and, at $300 a pop, a meaningful source of income. Gooberman invited television and newspaper journalists to witness and report on his procedure. The journalists came and interviewed some of Gooberman's many satisfied customers.
The doctor put up billboards in ghettos where addicts buy their fixes, and on I- 95 and the Ben Franklin Bridge, roads their families might travel.
The conservative CPA in Barbara didn't approve of her husband's marketing. "I just didn't like that his colleagues were giving him such a hard time," she says. "It didn't feel right. It was too risky. Just like Lance injecting himself with the naltrexone."
Now, however, Barbara sees things differently, thanks to Pete Musser, the CEO of Safeguard Scientific. Musser recently spoke to one of her MBA classes at Drexel-a course in entrepreneurship. "Pete said there are two kinds of people in this world," Barbara says. "He said there are Tiggers, and there are Eeyores. The Tiggers are the risk-takers, the ones who are successful; the Eeyores are the ones who always look for reasons not to take risks. Lance is a Tigger."
For a while, that Tigger aggressiveness paid off.
At the time, heroin use was surging. The National Institute on Drug Abuse's most recent report had found a national rise in heroin use. NIDA conservatively estimated that the number of addicts had jumped from 68,000 in 1993 to 325,000 in 1997; and warned that eighth-, 10th- and 12th-graders were increasingly experimenting with the drug. The number of opiate addicts in the United States, according to the NIDA study, was probably north of 800,000.
More and more affluent suburbanites were trying the drug for two reasons: price and purity. At $10 a dose, heroin was cheaper than cocaine, pot, even a six-pack of decent beer. And because the drug was becoming so pure-the heroin sold on Philly streets was, and is, some of the most potent in the country-it could be snorted or smoked, enticing those who might not risk injecting the drug for fear of contracting HIV.
As heroin became more popular, so, too, did Gooberman's ROD practice.
But then his patients started dying.
Michael Cary Jaslow's parents, Edward and Joan, will say very little about their 44 -year-old son's death or his drug problem-how he got hooked on heroin, how long he had used, what other detox methods, if any, he tried. They are reluctant partly because they are considering filing suit, and partly because it's still too painful.
Reached by phone, Joan almost immediately crumbles into tears. "I just visited his grave yesterday," she says. "I just can't … I will tell you this-there is nothing worse than having your son die in your arms."
What is certain about Jaslow, in addition to the fact that he left behind a brother and two grief-stricken parents, is that he was a graduate of Plymouth-Whitemarsh High School, where he wrestled on a championship team. Eventually, he joined his family's company, Jaslow Dental Laboratory, Inc., in Jenkintown, and became a vice president. The fair-haired exec had an active social life, dating frequently, and donated money to animal-rights organizations.
At some point, he became a functional heroin addict. According to his father, Jaslow never missed a day of work and showed no physical signs of his addiction. And on March 16, 1998, not long after Jaslow saw one of the half-dozen billboards Gooberman had posted around the Delaware Valley-and saw the doctor on television-he scheduled an appointment at Gooberman's office. He paid somewhere between $2,500 and $3,600, depending on the amount of drugs he had in his system, to undergo rapid opiate detox.
After a certified nurse anesthetist put Jaslow under at 8 a.m. on that spring day, he was intubated to keep his airway open. Gooberman's associate, Dr. Michael Bradway, then injected him with a handful of medications such as antidiarrheal octreatide, an anti-emectic to stem vomiting, and clonidine and benzodiazepines for other withdrawal symptoms. Finally, Bradway made a small incision in Jaslow's abdomen and injected the naltrexone pellet.
Jaslow awoke almost four hours later, at 11:45 a.m. If his ROD was anything like the many featured in the television shows and news reports, a nurse, or an orderly, or a doctor, or perhaps all three, greeted the groggy Jaslow as he opened his eyes. One of them coached him to bend his arms and take it easy, told him he still might experience some withdrawal symptoms, but proclaimed something like, "You're clean now. You have a chance to start over."
As soon as Jaslow could shuffle for about 300 feet, Gooberman's staff permitted him to leave with a guardian, who had signed a contract with the clinic promising to stay with Jaslow for the next 48 hours.
Eighteen hours later, Jaslow died in his mother's arms. Neither the New Jersey Attorney General's office nor the Montgomery County Coroner's office will reveal his specific cause of death. (In many countries, autopsies are not public record.)
Jaslow wasn't the first Gooberman patient to die within hours of undergoing ROD. In September 1995, just as Gooberman was beginning to perform the procedure regularly at his office, Pottstown's 41 -year-old Gerry Wolfe died from "acute necrotizing pneumonia" three days after ROD. The coroner reportedly said it was "possible" that Wolfe's pneumonia could have been caused by an improperly inserted or a contaminated breathing tube.
Two days before Christmas 1996, wealthy 43 -year-old contractor Frank Stavola Jr. of North Jersey, died less than eight hours after he underwent ROD. Cause of death, according to an official: pulmonary edema due to drug abuse.
Three months later, a 31 -year-old patient died about 10 hours after leaving the clinic. (The New Jersey State A.G.'s office has managed to keep the identities of two of the dead patients confidential.) Then, three months after Jaslow's death, a 50 -year-old patient became the fifth Gooberman ROD mortality, about eight hours after the procedure. Finally, last June, 20 -year-old Lisa Ann Flowers died of a heart attack "following rapid opiate detoxification," according to the Ocean County prosecutor's office, about 18 and a half hours after ROD.
Mark Herr, a spokesman for the New Jersey Attorney General's office, says Wolfe's death certainly made his office curious, but not suspicious. The truth, he says, was that, under those vague semantics of "undue risk," there wasn't much the A.G.'s office could do. "We became concerned when the others started dying," he says.
Now, armed with the six deaths and reports that several other patients went to emergency rooms, attorneys for the state claim Gooberman and his employee, Bradway, were "a clear and imminent danger to the public's health, safety and welfare" and engaged in "gross and repeated malpractice, negligence and incompetence."
In the complaint it filed last September, the state specifically alleged that there are no objective studies proving the effectiveness of the pellet or ROD; that Gooberman failed to properly screen his ROD patients; that he failed to clearly identify death as a risk factor in the informed consent form signed by patients; and that he failed to provide adequate aftercare for his patients.
Gooberman's attorney denies all of the charges and says his client learned of each of the deaths shortly after they occurred, when his staff made the standard follow-up phone calls to check on patients. Within 24 hours of hearing about each of the deaths, Gooberman's attorney says, she notified the medical board, as required by law.
"It hasn't been shown that there is a relationship between having had the procedure and having died," Gooberman says. "It's unfortunate when anyone dies. … But this happened over the span of five years, and these were very sick people."
He says that at least three of the patients who died had taken cocaine shortly after the procedure, which he absolutely warns his patients could kill them and is outlined in the informed consent he makes them sign.
Gooberman also points out that he has treated more than 2,150 patients. "A lot of the patients who come to see me, their [loved ones] are losing them, anyway. … A mother and son came into my office, and I was trying to explain the risks and benefits of the procedure before I did it on her son, and [the mother] wasn't listening. I got angry. I said, 'Listen, this is important.' … She said, 'Don't tell me how important this is. This is my second son. My first one is gone already. I don't care what the risks are, I don't want to lose him.'"
A handful of doctors is performing ROD around the country, in places like Denver and Los Angeles, and there is an outpatient ROD clinic in Connecticut similar to the one Gooberman ran. While prominent physicians in addiction medicine continue to debate the effectiveness of ROD, nearly all seem to agree Gooberman has crossed a line. "I know all about Dr. Gooberman and what's going on over there. Gooberman is a creep," Dr. Colin Brewer says from his London office. Brewer, a respected pioneer of ROD, first employed the antidiarrheal octreatide in the procedure and actually visited Gooberman's office a few years ago. "Gooberman is a one-size fits-all chap," he says. "Not everyone who goes to see Dr. Gooberman needs ROD.
"The treatment is useful," Brewer continues, "but people like Gooberman are giving it a bad name by poor patient selection and preparation and rampant commercialism, as well as by prematurely discharging patients."
"General anesthesia," says Dr. James W. Cornish, an assistant professor of psychiatry and the director of the pharmacotherapy division at the University of Pennsylvania, "carries risk all by itself. Generally, detoxification has no lethality. And when you introduce anesthesia, you might be introducing an undue risk." According to Cornish, current data show that one in five of all patients who undergo anesthesia have a bad result. "And if you look at the literature," he says, "any [detox] associated with anesthesia was looked at as experimental."
Dr. Herbert Kleber is a professor of psychiatry and the director of the division on substance abuse at Columbia University and one of those physicians responsible for the ROD advancements made at Yale. Almost since the day Gooberman went into business four years ago, Kleber has been his most vocal critic. Although Kleber will not offer on-the-record comments about Gooberman now-because the A.G.'s office has hired him as a chief witness-in 1998, he published an editorial in The Addiction Journal that seemed to target the Merchantville doc. Kleber wrote: "While some see [RODs] as a 'magic bullet,' a miracle breakthrough, others see them as a shameless exploitation of the addict and the general public, use of a technique with potential serious morbidity and mortality for a condition-opiate withdrawal-that, while painful, is not associated with mortality."
Each of these detractors, however, can be perceived as having an ulterior motive. Brewer and Gooberman, for example, are currently embroiled in a squabble over a patent for the ROD methodology employing the antidiarrheal drug. Brewer says Gooberman duped him into cooperating with his efforts to patent the procedure.
"Contrary to all his assurances," the British doc says, "Gooberman has taken out a restrictive patent. If I were practicing in the States, which I have no intention of doing, I would be unable to use octreatide in the detoxification. I have, for the public good, filed a counter-patent. It's not for financial motivation. I'm doing my bit to stop Gooberman and his disgusting Americanism."
For the past seven years, Cornish has been working with a company called BioTek, testing his own long-lasting form of naltrexone. Cornish believes he has an injectible that, just as Gooberman claims of his pellet, will suppress heroin craving for 30 days. "We have followed the traditional path for carrying out studies under guidance from the FDA," Cornish says. "As far as I know, Dr. Gooberman has not."
And last September, NIDA awarded Kleber a $2.5 million grant to study ROD. In fact, the editorial he wrote that same year could be read as one big grant application built on bashing Gooberman. "He just got $2.5 million," Gooberman says, referring to Kleber. "He's the one who stands the most to gain if the board shuts me down. Then he can get into the ROD business."
Kleber denies any link between his editorial and the grant money.
But these competing interests hint at something more than coincidence and may support Gooberman's theory that he is being unfairly persecuted for reasons bigger than what meets the eye.
While treating people like addicts is the cornerstone of the Hippocratic oath, the reality is that millions of people are dying, sometimes literally, to get off heroin, and anyone who comes up with the most advanced, most effective treatment stands to make big bucks-or, at the very least, ride a high of prestige.
To achieve that end, addiction-treatment physicians and researchers must look to federal and state agencies for research capital, as Kleber has done, or go to the private sector, like Cornish. They must adhere to protocol and be patient. Or they could challenge the medical establishment and take risks, but never any undue risks.
On the wall of his den, Gooberman has a picture of himself flying a paraplane-one of those single-engine things with a parachute instead of wings. In the photograph, he's dressed in what looks like a silver astronaut costume, heading right toward the camera, high above a body of water. An inscription along the bottom of the picture reads: SOMETHING ABOUT TAKING RISKS.
The picture reminds Gooberman of a time when he took off in his paraplane, high on Valium and "maybe some other stuff." He was going to show his buddies what it was to "really get high." He cruised to 2,300 feet, soared over the Commodore Barry Bridge and headed directly for the airport. "So there I am with a 727 coming out of Philadelphia International, and I figure I got the right of way," he says.
He laughs as if to say, I know it's not funny, then continues his story: "I start yelling at the pilot of the 727, not that he could hear me. Thank God he changed course and went up. He didn't even need to hit me; the wash from his engines would have dumped the air out of my shoot. On my way back across the Delaware River, I ran out of gas and crash-landed in a cornfield, bent my front wheel. That was probably the craziest thing I ever did."
Right now, that's for a judge to decide.