How an AI tool explained Ruan v. United States to doctors

As a health care educator with three decades of experience in research and hundreds of published papers, I have written at some length both on KevinMD and in clinical journals, concerning the dangers of artificial intelligence in medicine. I have also recently written about the profound differences between meanings of the term “Red Flag” in legal versus clinical contexts. Moreover, I have declared that predictive algorithms on patient risk of addiction are unsupported by science and potentially comprise a violation of U.S. constitutional law.

With these things being acknowledged, we must also recognize that artificial intelligence allows authors to accomplish some remarkable things in relatively short times, by surveying and combining large bodies of data to generate a coherent narrative. Some AI tools produce not only text, but also virtual “interviews” that can reach and influence large audiences that may not have a strong background in the underlying science. I take as my example in this field an entry from the online blog of pharmacist Norman Clements: You Are Within the Norms.

Dr. Clements started from my recent article concerning Red Flags, on KevinMD. He quotes from it verbatim at length, acknowledging the source. He has combined that article with additional sources, among them the observations of Daniel Harris, MD, HMDC, around which I organized the Red Flags article. However, he applies AI-based tools (in this case NotebookLM, now called Gemini Notebook) to take his readers much further than I did.

Dr. Clements comes to these issues with a great deal of motivation and considerably greater familiarity than my own, with powerful interview-generating AI-based tools like NotebookLM. His motivation stems in part from having successfully defeated a Drug Enforcement Administration (DEA) investigation and their efforts to force his pharmacy out of business. After months of fruitless contention and confiscations of his working records and some pharmacy equipment, DEA was forced to close its investigation of Dr. Clements’ pharmacy business and to return all of the equipment and records that they confiscated. No charges were ever filed against Clements or any of his employees despite months of what arguably amounted to repeated harassment. He retains his licenses to practice pharmacy in two U.S. states and continues to run his business.

With respect to AI-based technology and physician defense in adversarial proceedings, Dr. Clements has accomplished much more. In his recent blog entry, he applies the AI-based interview generator capabilities of NotebookLM to produce a 42-minute, two-voice virtual interview derived from my previous Red Flags article on KevinMD. This interview effectively undermines the legal reasoning for what might be a huge majority of DEA future actions against clinicians who have done nothing wrong except trying to help patients in agony. Moreover, Dr. Clements relates that the AI engine itself “volunteered” follow-up questions that took him much deeper into pertinent issues than he initially expected to go.

• In the two-person interview on You Are Within the Norms, Dr. Clements and NotebookLM first summarize my observation that at least four of the factors that DEA frequently employs in criminal or administrative courts to convict clinicians of practicing outside of usual and customary medicine are in fact illogical and easily explained as outcomes of actions by the DEA itself.
• NotebookLM then proposed, without further prompting by Dr. Clements, to discuss major changes in legal practice introduced by the U.S. Supreme Court decision in Ruan v. United States. As a consequence of the Ruan decision, prosecutors must now prove beyond a reasonable doubt that (a) there actually is a widely accepted consensus standard for practices that comprise usual and accepted practice, (b) that the clinician knew of this consensus standard, and (c) that the clinician consciously chose to ignore the standard. This is a much more difficult standard of proof than before Ruan.
• Perhaps most startling of all, NotebookLM then asked Dr. Clements if he might wish to hear an example legal brief such as a defense attorney might use in court. When Dr. Clements agreed, NotebookLM generated a doctor defense brief that effectively refutes DEA prosecutors’ and subject matter experts’ court arguments.
• Dr. Clements and NotebookLM finally lead listeners to understand that the Ruan decision potentially creates a legal option for every doctor who was convicted under pre-Ruan standards of “objective” proof. This option might be implemented under federal law 28 U.S.C. Section 2255. This law pertains to motions to vacate, set aside, or correct a sentence. Sources processed by NotebookLM suggest that doctors might not only apply for immediate release on constitutional grounds, but they may also seek substantial financial compensation for malicious prosecutions they have experienced in pre-Ruan court actions that are now unconstitutional.

In effect, this AI-based interview tool has provided lawyers with a year of focused education in the defense of clinicians who have been sent to prison on invalid grounds under an unconstitutional standard.

One final precautionary note is due in closing: The author is personally unaware of any case in which a doctor has actually been released after demonstrating that the law as it was applied to them in the pre-Ruan era was unconstitutional. The situation, it seems to me, simply begs for a definitive test case.

Richard A. Lawhern is a nationally recognized health care educator and patient advocate who has spent nearly three decades researching pain management and addiction policy. His extensive body of work, including over 300 published papers and interviews, reflects a deep critique of U.S. health care agencies and their approaches to chronic pain treatment. Now retired from formal academic and hospital affiliations, Richard continues to engage with professional and public audiences through platforms such as LinkedIn, Facebook, and his contributions to KevinMD. His advocacy extends to online communities like Protect People in Pain, where he works to elevate the voices of patients navigating restrictive opioid policies. Among his many publications is a guideline on opioid use for chronic non-cancer pain, reflecting his commitment to evidence-based reform in pain medicine.