The Medical Profession, Moral Entrepreneurship, Moral Panics, and Social Control

The Medical Profession, Moral Entrepreneurship, Moral Panics, and Social Control.

 “Few, no matter how desperate, seek help of their own accord.”  says Dr. Marv Seppala, M.D., Chief Medical Officer at Hazelden, one of the “PHP-approved” drug and alcohol assessment and treatment centers located in Center City, Minnesota.  “Physicians are intelligent and skilled at hiding their addictions.”

“They’re often described as the best workers in the hospital,” he says. “They’ll overwork to compensate for other ways in which they may be falling short, and to protect their supply. They’ll sign up for extra call and show up for rounds they don’t have to do.”

In reality this is ludicrous–knee slapping absurd.   If the results of this authoritative opinion were not so dire these statements would, in fact, be comical.   Such is not the case, however, and opinions like Seppala’s have been taken at face value and, as a result, the aftermath has been and continues to be tragedy.IMG_0706

Addiction, alcoholism and substance abuse to any significant degree produce both physiological and behavioral manifestations in the user. It is cause and effect.  Pathophysiology conforms to law of nature and not the whims of the impaired physician movement.

What anomalous  aspect of intelligence or special skill set would enable a doctor to hide an addiction?

The ASAM definition of addiction is characterized by cognitive, behavioral and emotional changes which include “impaired control” so how would intelligence rein it in?  Furthermore, what unique logical, rational, analytical, factual, abstract, intuitive or objective aspect of intelligence is responsible for this preternatural fortitude?

How is the intelligence of a doctor any different from the intelligence of any other human being?  And what prodigious abilities do doctors have that enable them them to cloak the  behavioral manifestations and stave off the physical consequences chemical addiction to such a degree that they are able to maintain the facade of being  “described as the best workers in the hospital?”  Is it an innate inborn endowment or an esoteric knack acquired during medical training?

IMG_0728What ability and artistry would allow a profession to weave such a web of fortitude that they can convincingly shroud the myriad signs and symptoms of drug and alcohol abuse unlike the regular folk?    Perhaps access to ophthalmic vasoconstrictors and beta blockers to temper the pupillary dilation and tremulousness associated with stimulants or botox and a testosterone patch to mask the skin changes and maintain lean muscle mass in the throes of alcoholism?

How does overworking “protect their supply” and why would they keep it at the hospital?  These people have prescription pads and last I checked there were no cocktails shakers or bottles of Jameson in the doctors lounge.

And for the life of me I cannot comprehend why an alcoholic or addict doctor would sign up for extra call and show up for rounds on his day off.  What would be the point?

In reality a doctor with a drug or alcohol problem would be erratic with call and show up late for rounds.

This is just another example of authoritative opinion with no substantive value. It is moral entrepreneurship at its finest; the fallacy of appeal to authority and secret knowledge.

If Seppala were asked to provide the evidence-base and rationality of these statements he would be hard pressed to do so.  The question would be met with deflection, logical fallacy, references to the opinions of like minds and thought-stopping memes.  “You need a check-up from the neck up,”  your best thinking got you here,”  there is no “I” in “team,” “denial isn’t just a river in Egypt.”  Oh, yeah?   well “Rogue” isn’t just a river in Oregon and, while we are at it, “Boring” isn’t just a town!

It is this type of misinformation and propaganda that allows the “impaired physician movement” to  drag away the “best worker in the hospital” and deem him “in denial.”

“We were so surprised. We didn’t even know he had a problem”  say the nurses, patients and colleagues left behind.

Well the truth is he probably didn’t!

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Blind-faith and unquestioning allegiance to expert authority deflects scrutiny and analysis.  Few red flags are raised as this type of moral preening promotes misguided plausibility and complacency in the belief that these are indeed experts with good intentions. This needs to be addressed.

But if you look at any of the current “moral panics” that are being used to suggest random suspicion-less drug testing of doctors or promoting the Physician Health Programs as successful and replicable models, you will inevitably find a doctor on this list behind it. It is a given.

And the invitation goes out to Seppala to debate this in a public forum on a level playing field.    Not gonna happen because it would be impossible for him to address and answer the questions rationally,  directly and with any tiny scrap of evidence based data.

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11 thoughts on “The Medical Profession, Moral Entrepreneurship, Moral Panics, and Social Control

  1. Reblogged this on Chaotic Pharmacology and commented:
    Very interesting analysis.

    I am reblogging this post in chaoticpharmacology.com because I believe this is a very important topic that is usually ignored, perhaps because few people have the courage or knowledge to discuss appropriately about this difficult topics. I am also adding the URLs to two BMJ articles and other resources which I believe are related to this article.

    1. Strang John, Wilks Michael, Wells Brian, Marshall Jane. Missed problems and missed opportunities for addicted doctors
    We need a special service for doctors addicted to drugs or alcohol
    BMJ 1998; 316:405. http://www.bmj.com/content/316/7129/405

    2. Knowing the score: a doctor addict tells his story BMJ 2010; 341:c3725.
    http://www.bmj.com/content/341/bmj.c3725

    3. Special Investigation: Why ARE so many doctors addicted to drink or drugs? http://www.dailymail.co.uk/news/article-1277955/Special-Investigation-Why-ARE-doctors-addicted-drink-drugs.html#ixzz3K9ag8EEX – DailyMail

    4 .Should doctors and other healthcare workers be subject to drug tests at work? BMJ Doc2Doc forum:
    http://doc2doc.bmj.com/forums/off-duty_news-media_should-doctors-other-healthcare-workers-subject-drug-tests-work?plckPollKey=PollKey%3A3d967a73-da98-4702-9405-f732284d1559&utm_medium=email&utm_campaign=17582&utm_content=Should%20doctors%20face%20drug%20testing%20at%20work%3F&utm_term=Should%20doctors%20face%20drug%20tests%20at%20work%3F&utm_source=Adestra_doc2doc

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  2. Thank you–not only is it patently ignored, but there has been absolutely no academic analysis of either the junk-science (Etg, PEth, Scram, Soberlink, EtS,..) or the “new paradigm;” let alone a Cochrane evidence-base or IOM conflict of interest critique. This is due to a confluence of factors but it is urgent this be done as soon as possible before the inevitable spread to other groups as outlined in the ASAM White Paper.

    Like

  3. This could be or rather is such a threatening issue… Didn’t realize it existed to such a level.. Will sometime try to contact doctors here in India to check whether the misuse of medical knowledge happens here to an alarming level or not.

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  4. […] A Medscape article from   “Drug abuse among Doctors: Easy, Tempting, and Not Uncommon” is a prototypical example of the propaganda and misinformation being used to sway public policy and opinion.  Focusing on a small study  ( n =55) done by Lisa Merlo (Director of Research for the Florida PHP). Dr.Marvin Seppala  states in the article that impaired  doctors are: […]

    Like

  5. Reblogged this on Disrupted Physician and commented:

    Blind-faith and unquestioning allegiance to expert authority deflects scrutiny and analysis. Few red flags are raised as this type of moral preening promotes misguided plausibility and complacency in the belief that these are indeed experts with good intentions. This needs to be addressed.

    But if you look at any of the current “moral panics” that are being used to suggest random suspicion-less drug testing of doctors or promoting the Physician Health Programs as successful and replicable models, you will inevitably find a doctor on this list behind it. It is a given.

    And the invitation goes out to Seppala to debate this in a public forum on a level playing field. Not gonna happen because it would be impossible for him to address and answer the questions rationally, directly and with any tiny scrap of evidence based data.

    Like

  6. […] A Medscape article from   “Drug abuse among Doctors: Easy, Tempting, and Not Uncommon” is a prototypical example of the propaganda and misinformation being used to sway public policy and opinion.  Focusing on a small study  ( n =55) done by Lisa Merlo (Director of Research for the Florida PHP). Dr.Marvin Seppala  states in the article that impaired  doctors are: […]

    Like

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