Organizational Purpose and Public Trust in Drug and Alcohol Testing

Organizational Purpose and Public Trust in Drug and Alcohol Testing

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http://www.nytimes.com/2014/03/13/opinion/why-arent-doctors-drug-tested.html?partner=rss&emc=rss&_r=0

In 2012 Robert Dupont delivered the keynote speech at the Drug and Alcohol Testing Industry Association annual conference and described a “new paradigm” for addiction and substance abuse treatment of zero tolerance for alcohol and drug use that is enforced by monitoring with frequent random drug and alcohol tests. Detection of any substances is met with swift and certain consequences. He proposed expansion of this paradigm to other populations including workplace, healthcare, and schools. Based on the state Physician Health Program model of “contingency management,” with frequent testing and a point of “leverage,” such as a medical license in doctors, that is used as a behavioral incentive.

The ASAM White Paper on drug testing seems to indicate a desire to liberalize drug testing by utilizing health care providers in the process. Currently forensic drug testing uses a strict chain-of-custody protocol with Medical Review Officer (MRO) review. But if the result of a positive test is “therapeutic” rather than “punitive” this is unnecessary. In the “new paradigm” a positive test simply requires an evaluation at a “PHP-approved” facility.

IMG_9516 Accountability needs to be rooted in organizational purpose and public trust.

A recent article in JAMA, “Identification of Physician Impairment”  suggests that undetected physician impairment  may be contributing to medical error and that sentinel-event and  random alcohol-drug testing could be implemented to address the problem as is being done in the  current “Physician Health Program (PHP)” system.

The most consequential and critical issue for physicians, if this comes to fruition, is who will be in organizational and managerial control of the system and what ideological influences will be guiding policy and practice.   It is concerning that one of the co-authors of this article, Greg Skipper, is a Fellow of the American Society of Addiction Medicine with strong ties to the 12-step treatment industry and drug testing industry.

History shows Lord Acton’s aphorism on absolute power to be repeatedly true.  Corruption is a virtually inevitable consequenphotoce of unchecked power. The only two factors that constrain corruption are moral virtue and deterrence.

Disregard for standards of care and violations of codes of conduct are common.  So too is the use of anything that furthers the agenda.  Pseudoscience, such as polygraph testing, previously deemed by the American Medical Association as an unscientific game of “chance,” and psychometric testing of dubious validity are being used for confirmation of diagnoses.

They introduced and brought to market junk science like the Ethyl Glucuronide  (EtG) biomarker for detecting alcohol use. The EtG was introduced by an FSPHP physician, marketed, and proselytized as an accurate and reliable test for alcohol. After setting an arbitrary cutoff of 100 to prove drinking he ruined countless careers and lives.

As the disaster toll increased it became clear the test was not very good. It became apparent the test was, in fact, very flawed and misguided as using an ultra sensitive poorly specific test for a substance environmentally ubiquitous precludes its forensic applicability.

Hand sanitizer, cosmetics, sauerkraut, and myriad other products were shown to result in an elevated EtG. Sensibly, the majority of drug testing and monitoring programs abandoned it. 

The market for the test decreased dramatically as the only customers left were drug monitoring programs in which the testers had absolute power and those being tested were absolutely powerless–programs like those run by the PHP.

This group has now introduced the Phosphatidylethanol (PEth) test as a confirmation test for EtG and USDTL mScreen Shot 2014-04-05 at 2.08.11 PMarketed it as the PEthStat.  

State Physician Health Programs are now using the EtG  and adding the PEth to confirm alcohol ingestion. And just as they did with the EtG the claims of reliability are grand but without foundation. 
All speculative A=B oversimplified thinking that ignores the myriad other factors involved. The science is empty if you remove the dregs of filler and puff.  And the conflicts of interest are mind-boggling.

Corporate Front Groups and Corruption in Medicine-Forensic fraud, conflicts of Interest and the Erosion of Trust

The ASAM and FSPHP are corporate front groups that have infiltrated organized medicine and gained tremendous sway. Advancing the multi-billion dollar 12-step rehab and drug testing industry agenda control has replaced conduct and ideology has trampled science and reason. As organizations without transparency, accountability, or regulation they have become reservoirs of bad medicine and corruption.

Accountability is  rooted in organizational purpose and public trust.  Unfortunately, humanitarian ideals have been trampled by the imposition of corporate front groups who advance  hidden agendas under guises of science and scholarship  and patinas of benevolence.  Rife with conflicts of interest, these groups obfuscate, mislead, and exploit us to further an underlying political agenda.  Healthcare and medicine has been infiltrated by various groups that pose a serious threat to both the humanitarian and evidence based aspects.

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11 thoughts on “Organizational Purpose and Public Trust in Drug and Alcohol Testing

  1. These programs cost money, have errors and simply go along with the whole attack on physicians from the ABMS who seem to think testing physicians in every G**damn way is the answer to all healthcare problems because it validates them with high incomes.
    If you have someone who appears intoxicated do the damn test. In this day of legal POT and stress on doctors who may be prescribed antidepressants or so many other drugs that truck drivers are taking which can only screw them if found in the blood/urine- this whole process of mistrust and attack on our profession must stop.
    Anyone driving a car can kill many people! When we start random drug testing on everyone, then it may be time for physicians to get in line. I mean everyone from the president , admiral, school teacher, Lawyers, politicians and cops!

    Liked by 1 person

  2. Social Programme Engineers! (E-Cigarettes) it is relevent to everything else!
    “……But I’d like to suggest that lying is actually the normal modus operandi of Tobacco Control, and indeed of all social engineering programmes. After all, if you are engaged in a social engineering programme intended to change people’s behaviour in respect of smoking, drinking, eating, or anything else, does it really matter whether or not lies are employed to achieve these aims? What if it’s lies that work best in changing behaviour? And if you primarily want to change people’s behaviour, you want to override their personal autonomy in any way you can. Personal autonomy is something you want to destroy in people. You don’t want any truths or facts or debates to hinder the process of gaining control over them, and making them do as you desire…….” https://cfrankdavis.wordpress.com/2015/04/23/institutionalised-lying/

    Liked by 1 person

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