And while we're in the judicial mode, why don't we pass laws that will scoop up three-pack-a-day smokers from the streets and get them on medication?

In fact, forced drug treatment could be used on all sorts of disabled people who show a lack of intention to get themselves on the road to health.

And if those beneficiaries of our largesse do not turn up at clinics to get their drugs, then we could send medical treatment squads into their homes.

This would not only be a kindly move, but let's face it, all those people who are ill and don't want to do something about it are costing the health care system a huge wad of money. This is not good for society.

Compliance with medical authority is everything! Non-compliance must be stopped!

Culture of Drug Therapy

Am I serious? No, I'm not. But I'm concerned that we're creating a culture that will continue to spawn medical ideology that sees forced drug therapy as some kind of a moral duty.

Medical authorities are already applying this type of spin in psychiatric treatment.

Last week, I questioned the insidious and highly promoted notion that lack of treatment of psychiatric patients in the community leads to more violence. I repeat: there is no evidence for this mangled interpretation of the available data.

Anyone who touts this violence nonsense grossly misunderstands how drug therapy of any kind must be viewed in the context of a total health-care approach. In psychiatry, it means understanding drug therapy in relation to community-based services. Unfortunately, the lack of sustained community treatment services in most parts of this country throws the care of psychiatric patients badly out of whack.

Need for Community Services

Such services were never provided in the first place when droves of patients began leaving psychiatric state hospitals several decades ago to live as outpatients. Too much emphasis was placed then (as is the case now) on the power of drugs to set things right for these patients. Instead of bolstering community support systems, the judicial system has become more actively engaged in forcing therapy.

And whenever there is a system change in medicine as audacious as the move to managed care, one can expect disruptions not only in doctor-patient relationships, but in access to services.

Those who advocate forced treatment are the desperados of modern medicine. They can no longer see human behavior in context. They have sold out to the "magic bullet" society, in which drugs have become the proclaimed cure-all for almost everything.

This is not to say that drugs can't help certain individuals. They most certainly do. But often that help must be provided with a medical system that cares for a wide spectrum of human needs.

But frankly, I might as well be screaming at the wind. My take on the drug enforcement trend in psychiatry is that it reflects an authoritarian trend that is stinking up a lot of medicine. Some of my previous columns, for example, have focused on forced treatment of children with HIV and improper use of anti-depression drugs in children. The outlandish use of Ritalin to quell what often is normal childhood energy in the classroom is yet another example of the quick fix mentality that is becoming more the norm.

While I would never advocate that the severely obese and the three-pack-a-day smokers be placed on forced drug regimens, it wouldn't surprise me in the least that we'll see the day come when this will be strongly advocated and even widely applied. I'm not kidding about this.

Next week, the most pernicious aspect of forced drug advocacy.