From: sharpjfa@aol.com
To: jzivot@emory.edu
Sent: 2/3/2018 12:09:38 PM Central Standard Time
Subject: Rebuttal: Dr. Zivot & Lethal Injection
Sent: 2/3/2018 12:09:38 PM Central Standard Time
Subject: Rebuttal: Dr. Zivot & Lethal Injection
From: Dudley Sharp, independent researcher, death penalty expert, former opponent, 832-439-2113, CV at bottom
The truthful media description for Dr. Zivot would be that he is an anti-death penalty activist, who happens to be an anesthesiologist.
Dr. Zivot: "Sodium thiopental is no longer in my pharmacology toolbox. Hospira, the last company to manufacture the drug, stopped making it to protest its use in carrying out the death penalty."
Sharp: Well, no (1).
2011, Hospira took sodium thiopental away from innocent patients, even though they knew it would not stop executions (1).
Hospira knew that thiopental was, rapidly, being replaced by propofol (2).
2007: "Thiopental is a barbiturate widely used as an intravenous agent for the rapid induction of general anesthesia, with consciousness being lost within 10–20 seconds. However, its use as an inducing agent is decreasing following the introduction of propofol." (2a)
2009: "Thiopental (sodium pentothal) has been the barbiturate most frequently used for induction of anesthesia in children, although more recently many clinicians have replaced it with propofol." (2b)
January 2011 - US Based Hospira stops making sodium thiopental.
Why? Logistics.
Hospira had moved thiopental production from North Carolina to Italy in 2010. The EU and drug manufacturers had been publicly, shamed by anti death penalty groups, starting in 2009 (1), because EU jurisdiction drugs were being used in US executions. Italy's constitution bans the death penalty and Italy told Hospira they had to guarantee that any Italy produced thiopental could not be used in US executions. Hospira couldn't or wouldn't and, therefore, shut down thiopental production.
Economics and logistics are the reasons Hospira stopped production.
Abbott Labs created sodium thiopental in the 1930's and was aware of the US' planned use of sodium thiopental, for executions, in 1979 and its first use in executions in 1982 (1). Abbott spun off Hospira in 2004.
Abott's/Hospira's "ethical" concerns, conveniently, showed up 30 years later, at, exactly the moment it served Hospira's logistical problem.
March, 2011 - Propofol replaces Thiopental in The WHO Model List Essential Medicines, 17th edition. Thiopental remains an alternate.
Ending thiopental production had no discernable effect on Hospira's stock. Stock followers long knew, at least since 2006, that propofol was replacing thiopental and Hospira was a huge pharmacutical company with many products, with thiopental a tiny fraction of its total revenue.
2015 Pfizer buys Hospira for $17 billion.
Dr. Zivot: "An executioner and the condemned are not the same as a doctor and a patient, though it is easy to see how similarities can be drawn."
Sharp: Of course, they are not, remotely, the same and it would be irrational to find them similar (1).
Dr. Zivot, all of a sudden agrees, within his next paragraph:
" . . . executioners are not doctors . . .". and, later, " States may choose to execute their citizens, but when they employ lethal injection, they are not practicing medicine." . . . stating the obvious, which is, they are not, of course, remotely, similar, as Dr. Zivot concedes, or not, depending on which of his paragraphs you choose.
Dr. Zivot: "As a physician, however, I am ethically prohibited from commenting on the details of lethal injection lest even casual association suggest support or oversight."
Sharp: Total nonsense (1), as it appears the doctor well knows, as he comments on lethal injection, often. Does he concede being unethical?
Dr. Zivot protests: "(Execution jurisdictions) are usurping the tools and arts of the medical trade and propagating a fiction."
Sharp: Here is Zivot's "fiction".
Dr. Zivot: " When I gave a patient sodium thiopental, it was a medicine whose purpose was to heal. When the state gave sodium thiopental to a prisoner, it was a poisonous chemical whose purpose was to kill."
Sharp: There is no fiction, of course. Zivot states clear reality (1), as he well knows, as do all.
Dr. Zivot continues:
"Missouri recently obtained propofol, an exceedingly important anesthetic agent, and threatened to use it for executions. It would have succeeded if not for the threat of sanction by the European Union, which opposes the death penalty. Because of our broken domestic drug manufacturing market, 90% of our propofol is produced in Europe. EU sanctions would have stopped propofol shipment to the U.S. and left physicians without this critical drug."
Sharp: Dr. Zivot appears to miss the ethical problem.
I, completely, agree with Dr. Zivot, that the manufacturer and the EU would have stopped all exports of the drug, to the US, which would have put millions of innocent patients at risk, even though the manufacturer and the EU both, well know, as with Hospira and sodium thiopental, that withholding the drug would not stop the executions and, only, harm patients, a threat they would have carried out, as detailed (1).
That's their moral compass. Save one convicted murderer and put millions of innocent patients at risk (1). The opposite of "do no harm" (1).
In that propofol consideration, we have this ethical result:
The governor of Missouri, knowing that the manufacturer and the EU would not hesitate to put millions of innocent patients at risk, removed propofol from the execution group, to spare those patients (1).
The governor, unhesitatingly, chose to spare the patients (1).
The EU and the manufacturer, unhesitatingly, would have chosen to sacrifice innocent patients (1), as Dr. Zivot, correctly, finds.
Dr. Zivot: "Most recently, Florida reported the use of midazolam, another essential medication, in an execution. Midazolam is in the class referred to as a benzodiazepine. These drugs replaced barbiturates, to a degree, because they were safer. That is, it is harder to kill someone with them. How Florida granted itself expertise in the use of midazolam, now repurposed as a chemical used to kill, is known only to Florida."
Sharp: Florida has access to anesthesiologists and pharmacologists. Is Dr. Zivot unaware? Evidently.
Dr. Zivot: "From an ethical perspective, I cannot make the case that a medicine in short supply (midazolam) should preferentially be used to kill rather than to heal."
Sharp: Nor can I.
I could not find that both midazolam and its substitute, propofol, were both in short supply at the time of Dr. Zivot's article. I have little doubt they could have been, but will depend upon Dr. Zivot, for some confirmation.
No response from Zivot as of Nov 2023.
Drug shortages are the norm and are a combination of some or all of low profits, high liability, medical personnel misusing drugs, causing huge judgments, bad management control, by the FDA, medical partners and manufacturers, as detailed (3), with this article reviewing those problems, all of which are caused by those in the medical profession (3), government and private.
Currently (2017-2018), I could not find FDA confirmation of a midazolam shortage or a shortage of its substitute, propofol (4).
Midazolam, very likely, would never have been used in more than 10 executions per year, less than one per month. How much midazolam is wasted or misused, every year, by those in the medical professions?
Most likely, medical professions waste huge multiples of what would be used in executions. I doubt anyone would question that. Doc, any ethical perspective on that?
Dr. Zivot: "What appears as humane is theater alone."
Sharp: Dr. Zivot, take a bow. The theatrics are all yours.
I agree with Dr. Zivot that we should do away with the lethal injection method of executions. However, for me, it is for practical reasons, not the very weak or false medical ethical reasons, presented by Dr. Zivot (1).
Joel Zivot, M.D., is an assistant professor of anesthesiology and also the medical director of the cardio-thoracic and vascular intensive care unit at Emory University School of Medicine in Atlanta.
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1) The Death Penalty & Medical Ethics Revisited
http://prodpinnc.blogspot.com/2015/09/the-death-penalty-medical-ethics.html
http://prodpinnc.blogspot.com/2015/09/the-death-penalty-medical-ethics.html
2a) Thiopental, John A. Davies, in xPharm: The Comprehensive Pharmacology Reference, 2007.
2b) Preoperative Evaluation, Premedication, and Induction of Anesthesia in A Practice of Anesthesia for Infants and Children (Fourth Edition), 2009, Elizabeth A. Ghazal, Charles J. Coté
and
"A comparative study of sodium thiopental and propofol in adenotonsillectomy surgery in children: MOPS score, incidence and severity of agitation", Samaneh Kouzegaran, Mohammad Hossein Moradi, Elahe Alahyari, Amir Sabertanha, Biomedical Research 2017; 28 (17): 7590-7593, https://pdfs.semanticscholar.org/c627/c58ae03c88fd7600a1a7e4816a73fb331718.pdf
3) US Propofol Drug Shortages: A Review of the Problem and Stakeholder Analysis, Christopher Hvisdas, PharmD Candidate, Andrea Lordan, PharmD Candidate, Laura T. Pizzi, PharmD, MPH, and Brandi N. Thoma, PharmD, American Health & Drug Benefits. 2013 May-Jun; 6(4): 171–175. PMCID: PMC4031712, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031712/
4) I believe this is the most recent list
FDA Drug Shortages, Current and Resolved Drug Shortages and Discontinuations Reported to FDA
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600+ pro death penalty quotes from murder victim's families &
3300+ from some of the greatest thinkers in history
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Victim Services
Victims' Voices
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Additional research, w/sources, w/fact checking/vetting & critical thinking, as required of everyone.
The Death Penalty: Justice & Saving More Innocents
and
Students, Academics & Journalists: Death Penalty Research
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Partial CV
