This is an Important Public Service Announcement (PSA): Physician health programs (PHPs) are not causing physician suicides: Illegitimate authority is.

 


The articles and  allegations of fraud, abuse and misconduct involving state physician health programs that have been reported since 2015 are very specific, very serious and now very very numerous.

Power is considered legitimate when those who exercise it are accepted as having the right to do so and the Federation of State Physician Health Programs (FSPHP) seems to have a lot of trouble with factual truth and reality.  As Daniel Patrick Moynihan famously said:  “Everyone’s entitled to their own opinion but not their own facts.”   What the FSPHP did was to build a myth that has assumed the appearance of reality.   It needs to be debunked not piecemeal as it was built over the past 30 years but in one fell swoop.

The factual reality is–it’s all a bunch of bullshit.  It needs to be debunked and studies have found that debunking is more successful when it provides information that enables recipients to update their mental models justifying this misinformation.

Screen Shot 2019-12-14 at 9.40.46 PMThe system as it is is  is fatally flawed.  We need to dismantle it in a revolutionary way.  It cannot be reformed.  We need to reframe the issues and they can be reframed through common-sense, facts, evidence and intellectually honest arguments, and basic virtue.   Illegitimate authority has controlled the narrative for far too long.

“To be a hero,” says Philip Zimbardo in his TedTalk The Psychology of Evil, “you have to learn to be a deviant, because you’re always going against the conformity of the group.” All Americans should be concerned here.  Illegitimate authority is causing too many doctors to take their own lives.  This needs to urgently be addressed.  We need boots to the ground and this is a call to arms. 

Anti-authoritarians question all authority and challenge and resist illegitimate authority.  George Orwell concluded that nothing crushes anti-authoritarianism and heroism more than overwhelming fear and such is the case here.  The battle for liberty and justice in the face of  tyranny and injustice in medicine requires a special kind deviancy and nonconformity.  Martin Luther King, Jr. called it “creative maladjustment.”

 

Screen Shot 2019-12-17 at 8.01.54 PMIllegitimate power and abusive authority cannot be bargained with.  They must be called out and removed.  As one of my personal hero’s Dietrich Bonhoeffer said:

“We are not to simply bandage the wounds of victims beneath the wheels of injustice, we are to drive a spoke into the wheel itself.”

The reason the FSPHP has  been able to get away with this fraud and abuse for so long is because no one was ever able to get a word in edgewise.  Their “authoritative pronouncements”  were never challenged  to a degree that required a response. That is until Pauline Anderson’s August 19, 2015 Medscape article  Physician Health Programs: More Harm Than Good?

 Past FSPHP President Doris Gunderson’s Response to Physician Health Programs: More Harm Than Good?  did not do so well.  She did not address any of the substantive issues that presented pertaining to criminal misconduct fraud and abuse.  She simply deflected them, claimed how great they were and blamed the victims.  And since this time hundreds and hundreds of  doctors, nurses, medical students and other health-care professionals have come forward. The details may differ but the stories are the same.  PHPs are not the problem.  The illegitimate power that is ethically and managerially guiding them is.  

A large body of cumulative evidence proving this is growing rapidly yet FSPHP President Paul Earley’s Fall 2019 President’s Message.  disregards all of these substantive issues.  He simply ignores them, claims how great they are and blames the victims.

This is also seen in  next FSPHP President Chris Bundy’s WPHP Setting the Record Straight Part 1. in response to attempts by physicians in Washington state to get back some basic rights and freedoms—Bundy was against it and in his blathering here he simply ignores the issues, claims how great they are and blames the victims.   In his response to the NEJM article “Practicing What We Preach — Ending Physician Health Program Bans on Opioid-Agonist Therapy” Bundy claims that there is no prohibition on opioid-agonist therapy.  The authors rebuttal takedown of Bundy is.priceless, 

It is critical to understand physician health programs (PHPs)  are not the problem. The illegitimate authority managing and guiding them is and this is their leadership!    The FSPHP pushed bad policy that cumulatively  removed individual rights and fundamental freedoms of doctors and gave them power and protection.  This policy was adopted by state medical licensing boards (MLBs)  without any meaningful opposition or inquiry.    

The logical fallacy is palpable and if this were a debate on a level playing field it would be over. Unless they can address the specific facts directly in an intellectually honest and logical argument using evidence backed by concrete facts the debate is over.

The articles and news reports critical of PHPs all contain logically coherent arguments and well documented facts that are presented in a way that people can independently fact check.  The responses from FSPHP leadership are not logical and they are not acceptable. .

 Steven Landsburg’s algorithm from The Big Questions is the optimal algorithm for any type of argument or information-sorting problem .

 If you’re objecting to a logical argument, try asking yourself exactly which line in that argument you’re objecting to. If you can’t identify the locus of your disagreement, you’re probably just blathering.

Appropriation involves changing the meaning of a discourse so that the balance of advantage and disadvantage is shifted in one’s favor.  There would never be a batter time to do so.

My first blog post on Disrupted Physician, “Three Shells and a Pea”  was written October 23, 2014 (attached below).   The title refers to a confidence trick  presented as a gambling game in which the victim is tricked into betting a sum of money (say $20) on the assumption they are playing a game of chance.  In tbe “shell game” the con-artist places 3 half-shells face  down on a table, slips a pea underneath one, and then slides the shells around while the player tries to track the shell with the pea under it.   The player never wins because it’s a fraud scheme with a pre-determined outcome and not a game of chance.  The victim always loses his money.   This is analogous to what is happening in state physician health programs (PHPs).  They have become fraud schemes with pre-determined outcomes and the victims not only always lose their money, but often their livelihoods and sometimes their lives.  

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The subtitle to the Disrupted Physician blog is : The Physician Wellness Movement and Illegitimate Authority:  The Need for Revolt and Reconstruction.”    The “Physician Wellness Movement” is what British sociologist G.V. Stimson refers to in his 1985 paper “Recent developments in professional control: the impaired physician movement in the USA” in which he states:  

“The impaired physician movement is characterized by a number of evangelical recovered alcoholic and addict physicians, whose recovery has been accompanied by an involvement in medical society and treatment programs. Their ability to make authoritative pronouncements on physician impairment is based on their own claim to insider’s knowledge.”

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A grifter is a con-artist; someone who cheats others out of money.  

The “recovered alcoholic and addict physicians” involved in medical societies [through PHPs] and [specialized]  treatment programs Stimson speaks of are the individuals who would go on to form the Federation of State Physician Health Programs (FSPHP) 5-years later in 1990 and 5-years later this same group would forge a relationship with the Federation of State Medical Boards (FSMB) when the medical directors of 8 state PHPs (all belonging to FSPHP) all claimed unusually high success rates in doctors who were  referred to their programs (and sent to the “specialized” treatment facilities) as part of the deal. 

“Salting the mine” refers to a scam in which gemstones or gold ore are planted in a mine for purposes of duping others into purchasing shares in a worthless or purchasing shares in a worthless or non-existent mining company.  These grifters would load shotguns with gold dust and shoot into the sides of a mine to give the appearance of rich ore hence the term “salting the mine.” The Great Diamond Hoax of 1872  is one such example.  The medical directors of the state PHPs claiming  80% success rates effectively “salted the mine” here and based on these claims the FSMB gave them a seat at the table of power.  They have been sitting there ever since.  This is when tyranny gained a foothold.

1995-Federal Bulletin (Vol82N3)  

In 2008 the FSPHP issued a Policy Statement on  illness_vs_impairment

In 2011 the FSMB-issued a Policy on Physician Impairment

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This is when PHPs took a nasty left turn.  This is because: 

 

 

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What the 2011 construct creates is a system of indirect coercion and extortion in which the PHP makes the threat and the MLB carries it out.  

Harvard psychiatrist Dr. J. Wesley Boyd, M.D. explains how this fraud scheme works in his Psychology Today articles  Why Physicians Who Need Psychiatric Care Go to Kansas (published in April 2019) and  Doctors Pay Up or Else Don’t Work  (published December 2019).  In his most recent article Boyd notes he is contacted roughly twice every month by a physician who is “effectively, being extorted” and concludes:

“…Until there is a groundswell of opposition against standard practices, profiteering on the backs of vulnerable physicians will continue.I look forward to the day when my phone stops ringing and my email inbox goes silent from doctors who have unnecessarily been forced into the PHP-evaluation racket.

Boyd has been trying to expose this corruption for a long time.   He and Dr. John Knight, M.D. wrote about these same problems in  Ethical and Managerial Considerations Regarding State Physician Health Programs  published in the Journal of Addiction Medicine in 2012.   With collectively more than 20 years as associate directors with the MA PHP, Knight and Boyd didn’t like what they were seeing and tried to expose it.  This paper was a milestone as it was the first paper ever published in a peer reviewed  medical journal critical of PHP practices.   Knight and Boyd are honest and decent doctors and they were removed from the MA PHP precisely because they are honest and decent doctors. Knight and Boyd are honest and decent doctors and they were removed from the MA PHP precisely because they are honest and decent doctors.

Pauline Anderson’s August 19, 2015 Medscape article  Physician Health Programs: More Harm Than Good? was also a milestone as it was the first mainstream medical news article critical of  PHP practices.  This was  followed by BMJ editor Jeanne Lenzer’s Physician Health Programs Under Fire June 30, 2016. 

PJ Randhawa’s investigative report  Doctors fear controversial program made to help them  on KSKD in St. Louis was another milestone as  the first television report to air on mainstream news.  Screen Shot 2019-12-14 at 10.31.49 AM

Since then multiple papers have been published in peer reviewed journals including  Systematic Abuse and Misuse of Psychiatry in the Medical Regulatory-Therapeutic Complex  (Winter 2018) and Coercion, Moral Injury, and Suicide in the Medical Regulatory-Therapeutic Complex (Summer 2019)  published in the Journal of American Physicians and Surgeons exploring in detail many of the same ethical issues as Boyd and Knight (including coercion, control, extortion and abuse of power).   

The most recent peer reviewed article is   Practicing What We Preach–Ending Physician Health Program Bans on Opioid-Agonist Therapy published  August 2019 in the NEJM which specifically addresses PHPs prohibition of opioid-agonists as an option for physicians with opioid-use disorder (OUD) monitored by state PHPs.

In Wes Boyd’s latest article he notes he is called by an average of 2 doctors every month  who are being extorted by this system.

Many of those are physicians who contacted me through my blog who have just been referred to the PHP that is when they can use  Wes’s help. I am contacted by 4-5  per week on average and many of those have already entered the system.   I spend an average of 4-hours per day speaking to those coerced and abused and whenever I do I remind them I have a GoFundme and ask them to  make a donation if they can. They almost never do. Many claim they will after graduating from their PHP and others cite privacy reasons for not donating but whatever the case may be almost no one ever donates to my fund but the same 20 who always do and I appreciate that.  But the simple fact of the matter is at this point I can no longer continue this blog or anything else if I do not make this GoFundme goal asap.  There is a judge here in Boston who was in the national  news because she let an undocumented immigrant out the back door to avoid ICE agents.  I am not making any political statement about that but the point is they started a Gofundme for her defense and it was 60K overnight donated from people  virtue signaling  yet I have been helping victims and trying to expose this racket for nearly 6-years and raising money is like pulling teeth.  Last week I spoke to 7-new people and I told every one of them I need help with this.  Not one has donated a nickel!

So here is the deal–I want to keep this up and I want to keep doing this.  I have gotten this far but without your help but it all vanishes in 6-days. So if you have enjoyed reading my blog, or if I have ever helped you in the past or if you want to help remove this illegitimate power currently controlling the profession of medicine and help me finish what I started then forGod’s sake please help me out here.!

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gf.me/u/w5u9gky

 

 

————————————————————-Three Shells and a Pea 

First post on disrupted physician.com October 22, 2014

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She likes a rigged game, you know what I mean?”
— R.P. Murphy in Ken Kesey’s One Flew Over the Cuckoo’s Nest

Published  in the March 17, 2014 newsletter Alcoholism and Drug Abuse Weekly, an article  entitled “Physician group urges focus on spiritual and psychosocial” describes a group of doctors who “emphasize that for all addictions, the psychosocial and spiritual interventions, including 12-step interventions must be included in the treatment process and,” according to founding board member Dr. Ken Thompson, M.D., “to not do so falls short of practicing good addiction medicine.”

With a “significant percentage” in 12-step recovery themselves, “they have formed a  group called “Like-Minded Docs,which has more than 150 physicians, many of whom are medical directors of top treatment programs and also members of the American Society of Addiction Medicine (ASAM).” Dr. Thompson is in fact the Medical Director of Caron treatment center in Pennsylvania. The group also includes the medical directors of Hazelden, Talbott, Marworth, Promises, and other assessment and treatment centers used by state regulatory agencies to evaluate and treat referred physicians.    The President of the American Society of Addiction Medicine is a Like-Minded Doc as is former White House Drug Czar (1973-1977) Robert Dupont. In addition, the physician who introduced the long-term alcohol biomarkers Ethyl-glucuronide (EtG),  Ethyl-sulfate (EtS), and Phosphatidylethanol (PEth) is a like-Minded Doc as is  Wayne Gavryck, The Medical Review Officer for the Massachusetts Physician Health Program PHS, Inc.  How does he reconcile his 12-step belief system with fraud and misconduct?   It is either doublethink or the A.A. spirituality persona is just a front.

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Although I  applaud the ideal of addressing the psychosocial and spiritual aspects of addiction and acknowledge that 12-step recovery is a treatment tool that can provide great benefit to some people, I do believe there is an inherent conflict-of-interest here. Having no strong feelings for or against A.A, I  view it through the same pluralistic and open-minded lens as I do religion or philosophy;  there are many paths to salvation and none superior. I have referred patients to A.A. myself  and see it as an option and a personal choice, one tool in the toolbox  that can provide great benefit to some people, do absolutely nothing for others and, in fact, harm some.   If it works for you good for you. Knock yourself out.  If not then let’s try something different.

So although the ideals of Like-Minded Docs are ostensibly laudable, the framework is not necessarily so.  What is  most concerning is a confluence of currents that preclude option and choice. It is a scaffold that can be used for coercion, control, and imposition. And this is exactly what is being done in many of the State Physician Health Programs (PHPs).

Originally funded by state medical societies and staffed by volunteer physicians, PHP’s were designed to help sick doctors and protect the public. But over the past decade these programs have undergone a sweeping transformation due to the influence of the American Society of Addiction Medicine (ASAM). Unlike Addiction Psychiatry, ASAM is not recognized by the American Board of Medical Specialties (ABMS). They created their own “board certification” (ABAM)  in 1986 and most physicians do not know that the only requirement is an M.D. in ANY specialty and some sort of experience in substance abuse.

Trumpeting the false dichotomy that addiction is a “brain disease” and not a “moral failing” while portraying themselves as altruistic advocates of the afflicted, the ASAM has cultivated an organization that exudes authority, knowledge, respectability, and advocacy. They have set forth definitions of addiction, shaped diagnostic criteria, dictated assessment protocols, and shaped public policy all under the guise of scholarship and compassion.

They introduced junk science such as the EtG and PEth alcohol biomarkers through Greg Skipper, FSPHP, ASAM, and another Like-Minded Doc.

They created the “moral panic” of a hidden cadre of drug addled and besotted doctors protected by a “culture of silence” disguised as some of the best workers in the hospital and in fact look “just like us.”  They introduced and promulgated the nebulous “disruptive physician” and successfully fostered a moral crusade to attack this huge hidden threat. And if you do a little searching you will find that their  next target is the “aging physician,”  demented doctors causing unseen mayhem and assailing the public good.  They are now  fomenting a call to arms to root out senility in medicine. It is the same tactic they used in the substance abusing and disruptive physician.  Social entrepreneurs.  Moral panic. Moral crusade.   With no evidence base and the use of  propaganda and disinformation they have convinced regulatory and administrative medicine that witches are real, witches are evil,  and they are the authority when it comes to witches and know how to identify and root them out with our witchpricking instruments.  And you know what?. It worked.

And by infiltrating state PHPs they have become the might and main of addiction medicine in the United States. By removing dissenters who disagreed with the groupthink they have taken over most of the state PHPs and organized under the Federation of State Physician Health Programs (FSPHP).

And the State PHPs under the FSPHP are very strict when it comes to choice in rehabilitation facilities for for physicians in need of assessments for substance abuse. In fact there is usually no choice in the matter.  The physician may be given a choice of facilities but that is a ruse as it is a false choice– smoke and mirrors sleight of hand. Deception.

As home to some of the countries top ranked hospitals and most prestigious medical schools Massachusetts is an international healthcare hub with world-class teaching, research, and clinical care. Two of the top three psychiatric hospitals in the United States as rated by U.S. News and World Report are found here in Massachusetts with McLean Hospital earning the top prize and Massachusetts General Hospital ranked number three. However, this medical mecca of learning and research is apparently unable to attract anyone with the competence and skill to assess a physician for addiction or substance abuse.

In Massachusetts if the State PHP, PHS,inc. feels a physician is in need of an assessment the evaluation must be done at “a facility experienced in the assessment and treatment of health care professionals.”  No exceptions. And apparently these esoteric skills are only found in Georgia, Arkansas, Alabama, Kansas, and a half dozen other far-away places.

With over 20 years experience with the Massachusetts PHP, Physicians Health Services, inc., Harvard Medical Schools Dr.’s John Knight and J. Wesley Boyd published an article in the Journal of Addiction Medicine last year concerning Ethical and Managerial Considerations Regarding State Physician Health Programs.

One of the issues they discussed was the conflicts of interest between the state PHPs and the evaluation centers. One comment I was surprised got past editorial review was that the treatment centers may “consciously or otherwise” tailor diagnosis and recommendations to the PHP’s impression of that physician. “consciously” tailoring a diagnosis is fraud. It is political abuse of psychiatry. It is unethical. It is, in fact, a crime.

If you cross-reference the  medical directors of the “PHP-preferred facilities”  with the list of LMD’s it is a perfect match.

Therefore when the PHP refers a physician for an evaluation and gives them a choice of an assessment facility there is no choice. It is three card monte. A shell game. Heads I win tails you lose.

 

 

The ASAM has imposed the prohibitionist chronic brain disease spiritual recovery model of addiction on the field of medicine. It is a system of coercion, control, and indoctrination. And another ASAM Like-Minded Doc, Robert Dupont, is calling this the “new paradigm” of addiction medicine and wants to spread it out to other venues including schools.

Like-Minded Docs solves the final piece of the puzzle. It explains why so many doctors across the country are claiming fabrication and manipulation of personality and cognitive tests to support nonexistent diagnoses. In evaluating a physician this group is not gathering data to form a hypothesis but making data fit a hypothesis that arrived well before the physician did.  And this may be part of the explanation for the recent marked increase in physician suicide. With guilt assumed from the start, no due process, no appeal, and no way out physicians are being bullied, demoralized, and dehumanized  to the point of hopelessness. This needs to end now.

 

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Medicine is predicated on competence, good-faith, and integrity. Medical ethics necessitates beneficence, respect, and autonomy. The scaffold erected here is designed for coercion and control. Exposure, transparency, and accountability are urgent. An evidence based Cochrane type assessment of their “research” and an Institute of Medicine Conflict of Interest review are long overdue. The emperor has no clothes and sunshine is the best disinfectant.

She likes a rigged game, you know what I mean?

 

 

 

One thought on “This is an Important Public Service Announcement (PSA): Physician health programs (PHPs) are not causing physician suicides: Illegitimate authority is.

  1. This is another spot on piece by Dr. Langan and it is appropriate that he publishes it at the end of the year in order to summarize the past years development in thinking. It is appropriate and apt that he quotes not only his contemporary peers and colleagues but draws from well established sources outside of the more acute contexts in order to illumate parallels to larger relevant principles. Dr. Langan’s skills of articulation paired with his astute observations and keen conceptualizations will bring us further and greater groundswell and prompt more to join him in his appropriately passionate call to arms. This is a state of the union address, and by union, I mean union. Although HARBR-USA, a complementary variant of Dr. Langan’s Disruptive Physician, might have some other things to add, there is nothing here in the present piece from which we would withhold our full endorsement. We regard Dr. Langan as a highly studied authority in these many matters and a trustworthy spokesman for the cause.

    Liked by 1 person

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