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Page Number: 32

12 

XIULU RUAN v. UNITED STATES 

ALITO, J., concurring
ALITO, J., concurring in judgment 

“except in pursuance of a written order” issued by a practi-
tioner “in the course of his professional practice only.”  §2, 
38 Stat. 786.  Arguably, the phrase “in the course of . . . pro-
fessional practice” could have been read to refer only to con-
duct that conforms to the standards of medical practice as 
a purely objective matter.  But our Harrison Act precedents
interpreted that phrase to refer to “bona fide medical prac-
tice,”  which  meant  that  any  prescription  issued  “in  good
faith” qualified as an authorized act of dispensing one of the
drugs proscribed by the statute.  Linder, 268 U. S., at 17– 
18; see also Boyd v. United States, 271 U. S. 104, 107 (1926); 
Webb v. United States, 249 U. S. 96, 99 (1919). 

Nothing in the CSA suggests that Congress intended to
depart from the preexisting understanding of action “in the 
course  of  professional  practice.”    We  have  previously  held
that  the  CSA  incorporates  settled  understandings  of  “the 
exemption  given  to  doctors”  to  dispense  controlled  sub-
stances “ ‘in the course of . . . professional practice’ ” under 
the Harrison Act.  Moore, 423 U. S., at 139–140 (quoting 38 
Stat. 786).  And the language of the CSA supports the same 
conclusions that we previously reached about the Harrison
Act.  As our CSA precedents have explained, to act “in the 
course of professional practice” is to engage in the practice
of medicine—or, as we have put it, to “act ‘as a physician.’ ”  
Moore,  423  U. S.,  at  141.    For  a  practitioner  to  “practice
medicine,” he or she must act for a medical purpose—which
means aiming to prevent, cure, or alleviate the symptoms
of a disease or injury—and must believe that the treatment 
is a medically legitimate means of treating the relevant dis-
ease or injury. 

But acting “as a physician” does not invariably mean act-
ing  as  a  good  physician,  as  an  objective  understanding  of 
the “in the course of professional practice” standard would 
suggest.  A  doctor  who  makes  negligent  or  even  reckless
mistakes in prescribing drugs is still “acting as a doctor”—
he or she is simply acting as a bad doctor.  The same cannot