An Open Letter to Senator Elizabeth Warren Regarding Laboratory Developed Tests, Physician Health Programs and Institutional Injustice

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—There is no place in science for consensus or opinion, only evidence.-Claude Bernard

Dear Senator Warren,

Thank you for your reply regarding laboratory developed tests (LDTs) and the need for regulatory oversight.   As you mention, LDTs are developed without FDA approval—a pathway in which is not even necessary to prove validity of a test (that it is actually testing what it claims to be testing for) to bring it to market. With no FDA oversight or regulation a commercial lab can claim any validity they want in marketing these tests. The regulation debate has focused on the reliability and validity of a number of clinical tests marketed with unverified claims of accuracy such as prenatal screening and Lyme disease and this lack of oversight is a direct threat to patient safety.

I am sure you would agree with me that the importance of tests diagnostic accuracy is directly proportional to that tests potential to cause patient harm if reported inaccurately.

Sensitivity and specificity are important components of any diagnostic test because there are consequences associated with both false-positive and false negative results.

A test falsely indicating the absence of a condition in someone who truly has it can delay or prevent needed treatment wile a test falsely indicating the presence of a condition in someone who does not truly have it can result in unnecessary testing and treatment.

Incorrect treatment and false labeling of patients can also occur. Therefore diagnostic accuracy is paramount if a test is being used as the basis for further tests and treatment. Any test being used as a basis for further tests or treatment needs to be accurate. It needs to be reliable and valid. Moreover, if the consequences of a test can result in significant patient harm (such as unneeded chemotherapy) it needs to be either 100% accurate or be combined with other tests to confirm the true diagnosis.

 “Forensic” vs. “Clinical” Laboratory Testing

“Forensic” testing differs from “clinical” testing because of the consequences and the process is tightly controlled because false-positive results are unacceptable as the consequences can be grave, far-reaching and even permanent.

Forensic testing demands special handling and safeguards to protect the donor such as validated tests, certified labs, strict chain-of-custody procedures and MRO (Medical Review Officer) review. These safeguards of quality control assure the validity and integrity of the specimen.   The LDT pathway was not designed for forensic tests.

Forensic Laboratory Developed Tests (LDTs)

 Paradoxically, laboratory developed tests with the potential to cause  life-changing and possibly irreparable harm have been absent from the regulatory debate; LDT drug and alcohol tests used for “forensic” monitoring purposes.

A panoply of tests using urine, blood, hair, fingernails breath and saliva have been developed and brought to market since 2003 when the first one was introduced by Gregory Skipper, then Medical Director of the Alabama Physicians Health Program, who “convinced the initial lab in the USA, NMS near Philadelphia to start performing EtG testing.” 1

Developed as an LDT, Skipper and NMS then claimed the alcohol biomarker (which was discovered in the 1950s) “appeared to be 100 percent specific” in detecting covert use of alcohol based on a study he coauthored that involved a mere 35 forensic psychiatric inpatients in Germany, all male. 2   With this “evidence-base” and a not yet published paper in the pipeline,3   Skipper then pitched the test to the Federation of State Medical Boards (FSMB) as an accurate and reliable tool detect covert alcohol use in health care professionals.

Policy Entrepreneurship

In  “Agendas, Alternatives, and Public Policies,”4 John W. Kingdon describes the problem, policy and political streams involved in public policy making.   When these three streams come together a specific problem becomes important on the agenda, policies matching the problem get attention, and then policy change becomes possible.

Kingdon also describes “policy entrepreneurs’ who use their knowledge of the process to further their own policy ends. They ‘lie in wait… with their solutions at hand, waiting for problems to float by to which they can attach their solutions, waiting for a development in the political stream they can use to their advantage.”4

And due to a perfect confluence of streams ( Institute of Medicine report that 44,000 people die each year due to medical error,5 media reports of “impaired physicians,”  the the war-on-drugs, etc.)  the FSMB was swayed into accepting not just the validity but the necessity of using an alcohol biomarker of unknown reliability and validity on doctors referred to or monitored by state Physician Health Programs (PHPs) .

As the national organization that gives guidance to state medical boards through public policy development and recommendations, the individual state medical boards adopted use of the test without critical appraisal and no meaningful opposition.

Shortly after its founding in 1912, the FSMB began publishing a  journal called the Quarterly of the Federation of State Boards of the United States. Now known as the Journal of Medical Regulation, the publication has archived all issues with full articles dating back to 1967 and, as the official journal of the national organization involved in  medical licensing and regulation this facilitates an unskewed and impartial examination of how and when specific issues and problems were presented and who presented them and, in doing so, the “policy entrepreneurship” Kingdon describes can be seen quite clearly. For example a 1995 issue containing articles written by the program directors of PHPs in 8 different states contains an FSMB editorial acknowledging the reported 90% success rate claimed of these programs (in part attributed to the 90-day inpatient treatment programs) that concludes:

“Cooperation and communication between the medical boards and the physician health programs must occur in an effort to protect the public while assisting impaired physicians in their recovery.” 6

No one bothered to examine the methodology of these reports to discern the validity of the claims and it is this acceptance of faith without objective assessment that has allowed the passage of flawed public policy in medical regulation.

Nowhere  is “policy entrepreneurship” more glaringly displayed as it is in a 2004 issue promoting the use of EtG in monitoring doctors as under the same cover is an article identifying both the need7 for such a test and an article providing the solution.8  

“Detection of Alcohol Use in Monitored Aftercare Programs: A National Survey of State Physician Health Programs,” a survey of state Physician Health Programs (PHPs) concludes that “surreptitious alcohol use” is a significant concern” for PHPs, there is no current  “best method” for detection,  but a promising new test  with “exceptional specificity (100 percent) and sensitivity” in detecting small amounts of alcohol for up to 18 hours has recently become available.7

This same issue contains an article authored by Skipper about a new marker “not detectable unless alcohol has been consumed” recently introduced in the United States and now commercially available.”8

Notably absent from both of these articles is Skipper’s role in the commercial availability of the test. This conflict-of-interest is nowhere mentioned in this display of “creating a market then filling it.”

This “regulatory sanctification” of the test implied its tacit approval by the medical profession  (i.e. “if they are using it on doctors it must be valid”) and facilitated its marketing  to other monitoring agencies (nurses, airline pilots) as well as  Courts and Probation Departments where those doing the monitoring had absolute power while those being monitored had no voice.

Bent Science

In Bending Science: How Special Interests Corrupt Public Health Research9, Thomas McGarity and Wendy Wagner describe how special interest groups scheme to advance their own economic or ideological goals by using carefully crafted distorted or “bent” science to influence legal, regulatory and public health policy.  The authors describe how those making these decisions often assume the information that reaches them has been sufficiently vetted by the scientific community as it flows through a pipeline of rigorous peer-review and professional oversight and that the final product that exits the pipeline is unbiased and produced in accordance with the norms and procedures of science.

McGarity and Wagner note the serious and sometimes horrific consequences of bent science and provide examples involving Tobacco and Big Pharma . The authors call for:

“..immediate action to reduce the role that bent science plays in regulatory and judicial decision making” and the need for the scientific community to be involved in “designing and implementing reform.”

“Shedding even a little light on how advocates bend policy -relevant science could go a long way toward remedying these problems.  Indeed, precisely because the advocates have overtaken the law in this area, heightened attention to the social costs of bending science could itself precipitate significant change.”

In the case of EtG this shedding of light is not very hard as no “carefully crafted” studies bending science were used to sway opinion.   None existed. The only items in the pipeline were directly related to Skipper.  If anyone dare to look, the Emperor has no clothes.

Lack of Answerability and Accountability

There are difficulties in challenging bent science including a general lack of recognition of the problem and an absence of counter-studies to oppose deliberately manufactured ends-oriented research.   This has proven true with the myriad LDTs introduced into the marketplace as no counter-forces or competing economic interests producing counter-studies exist.

Multiple lawsuits, including a class-action, have been decided in favor of the labs who have taken a stand-your-ground approach supported by a body of industry-related “research” they or their affiliates produced to support the validity and reliability of the tests.

Those affected by these tests either have no power or have had their power removed. Most do not have the resources to mount a defense let alone produce counter-studies questioning the reliability and validity of the tests.

Most employee drug testing follows Department of Health and Human Services (DHHS) guidelines using FDA-approved tests that have specific cutoff levels defining a positive-result in an effort to eliminate false-positive results.10  Procedural safeguards are in place in these programs to protect the donor.  Forensic testing programs using LDTs provide no such safeguards as the testing is unregulated and there is no oversight from outside actors.

Unlike clinical LDTs “forensic” LDTs are even exempt from CLIA oversight.   The only avenue for complaint is through the College of American Pathologists (CAP) and, as an accrediting agency, they can only address problems by ensuring compliance with CAP guidelines.   If an investigation concludes lab error or misconduct CAP can mandate the lab correct the test result and come into compliance with their guidelines under threat of loss of accreditation but no other consequences exist.  Accountability has been removed yet the  consequences to those harmed by these are significant and without remedy.

State Physician Health Programs

As is the case with the LDTs  they introduced, Physician Health Programs have no oversight or regulation.   A 2013 Audit of the North Carolina PHP 11 prompted by complaints from doctors and performed by State Auditor Beth Woods found absolutely no oversight of the program by either the state medical board or medical society and that “abuse could occur without being detected.”

The Audit also found that doctors were predominantly referred to the same “PHP-approved” out-of-state facilities to which they in part attribute their high success rates in treatment. Interestingly the PHP could not identify what quality indicators or quantitative measurements were used by the PHP to “approve” the “PHP-approved” facilities.

In January of 2015 a Federal class action lawsuit was filed in the Eastern District of Michigan against the state PHP program and found health care providers were subject to the same referral system using these out-of-state facilities. The suit alleges constitutional violations related to the forced medical treatment of health care professionals and the “callous and reckless termination of professional licenses without due process.” 12

As with North Carolina, the Michigan PHP will be unable to provide what quality indicators and quantitative measurements are being used to “qualify” and “approve these facilities.    None exist. The sole indicators for approving these assessment centers are ideological and economic. In fact, the medical directors of most, if not all, of these facilities can be seen on this list of “like-minded docs.” 

Institutional Injustice

You once said “People feel like the system is rigged against them. And here’s the painful part: they’re right. The system is rigged.”

So too is this system.

As the Michigan lawsuit notes: “Unfortunately, a once well-meaning program has turned into a highly punitive and involuntary program where health professionals are forced into extensive and unnecessary substance abuse/dependence treatment under the threat of the arbitrary application of pre-hearing deprivations.”

This has become the rule not the exception. The Federation of State Physician Health Programs (FSPHP), the same group to which Dr. Skipper belongs, has systematically taken over these programs state by state by removing competent and caring doctors not agreeing with the groupthink and silenced them under threat of litigation if they violate their confidentiality agreements and “peer review” statutes.

The same system of coercion, control and abuse exists in Massachusetts.  In the past week alone I have heard from a medical student, a resident and two doctors who complained of misconduct  misconduct involving fraudulent testing and falsified diagnoses.

In “Ethical and Managerial Considerations Regarding State Physician Health Programs,” published in the Journal of Addiction Medicine in 2012, Drs. John Knight, M.D. and J. Wesley Boyd, M.D., PhD who collectively have more than 20 years experience with the Massachusetts Physician Health Program (PHP) state that:

“Because PHP practices are unknown to most physicians before becoming a client of the PHP, many PHPs operate out- side the scrutiny of the medical community at large. Physicians referred to PHPs are often compromised to some degree, have very little power, and are, therefore, not in a position to voice what might be legitimate objections to a PHP’s practices.”13

Noting that “for most physicians, participation in a PHP evaluation is coercive, and once a PHP recommends monitoring, physicians have little choice but to cooperate with any and all recommendations if they wish to continue practicing medicine,” Knight and Boyd raise serious ethical and managerial questions about current PHP policies and practice including conflicts of interest in referrals for evaluation and treatment, lack of adherence to standards of care for forensic testing of substances of abuse, violations of ethical guidelines in PHP research, and conflicts of interest with state licensing boards.

Knight and Boyd recommend “the broader medical community begin to reassess PHP’s as a whole” and that “consideration be given toward the implementation of independent ethical oversight and establish and appeals process for PHP clients who feel they are being treated unfairly.” 13

They recommend the relationship between PHP’s and the evaluation and treatment centers and licensing boards be transparent and that national standards be developed “that can be debated by all physicians, not just those who work within PHPs.”13

Accountability, or answerability, is necessary to prevent corruption.  This requires both the provision of information and justification for actions.    What was done and why? Accountability also requires that consequences be imposed on those who engage in misconduct.

In discussing the financial conflicts-of-interest between PHPs and “PHP-approved” assessment centers Knight and Boyd state:

“..if a PHP highlights a physician as particularly problematic, the evaluation center might–whether consciously or otherwisetailor its diagnosis and recommendations in a way that will support the PHP’s impression of that physician.”  

To “consciously tailor a diagnosis” is fraud. It is political abuse of psychiatry. And it is not only the assessment and treatment centers willing to “tailor” a diagnosis; so too are the labs involved.

Physician Suicide

I can think of nothing more institutionally unjust than an unregulated zero-tolerance monitoring program with no oversight using unregulated drug and alcohol testing of unknown validity.   But that is what is occurring.   Some of us are trying to expose this corrupt system but barriers exist. As with the Laboratory Developed Tests (LDTs), those involved have intentionally taken steps to remove both answerability and accountability.  Both the tests and the body of individuals administering these tests are notable for their lack of transparency, oversight and regulation.  This renders them a power unto themselves.

Doctors (and others coerced into Professional Health Programs) across the country have reported going to law enforcement and state agencies only to be turned away.   The Federation of State Physician Health Programs (FSPHP)  has convinced these outside agencies that this is a “parochial” issue best handled by the medical profession..   Those reporting crimes are turned back over to the very people committing the crimes.

The Massachusetts Medical Society and Massachusetts DPH claim no oversight of the Massachusetts PHP, PHS.inc. The Massachusetts Board of Registration in Medicine (BORM) will not address ethical or even criminal complaints about the doctors involved in the PHP and there is good evidence that some members of the BORM are in fact complicit in unethical and even criminal behavior. As the Massachusetts AGO represents the BORM they defer issues back to them and dig no deeper.

Drs. Knight and Boyd have suggested State Audits and we are hoping that MA State Auditor Suzanne Bump will investigate the MA PHP and the Board of Registration in Medicine’s Physician Health and Compliance Unit shortly.

One major problem is that barriers have been put in place to prevent information from getting to the right people.

The majority of people at medical societies, boards, departments of public health and other organizations are individuals of integrity and honesty but the system has been erected so that valid complaints are deflected, delayed, dismissed or otherwise tabled by sympathizers, apologists and those complicity.   The criminal activity the Massachusetts PHP is engaging in is undeniable and indefensible but who is going to hold them to account?

It is going to take a while to reform this system of institutional abuse and it has to be done state by state. Please take a look at the facts and documentary evidence and help me hold them accountable. This needs to be exposed, acknowledged and addressed.   Doctors are dying from this system of institutional abuse. It is a public health emergency no one is talking about.  Yet those behind the PHP programs are claiming this system of coercion, abuse and control is the “gold standard” of addiction treatment and, using another loophole, they want to expand this system to mainstream healthcare.

Sincerely,

Michael L. Langan, M.D.

  1. Skipper G. Exploring the Reliability, Frequency, and Methods of Drug Testing: What is Enough to Ensure Compliance?:   Alcohol Markers and Devices. 2013; http://www.fsphp.org/Skipper, Exploring the Reliability Frequency and Methods 2 Presentation.pdf.
  2. Wurst FM, Vogel R, Jachau K, et al. Ethyl glucuronide discloses recent covert alcohol use not detected by standard testing in forensic psychiatric inpatients. Alcoholism, clinical and experimental research. Mar 2003;27(3):471-476.
  3. Skipper GE, Weinmann W, Thierauf A, et al. Ethyl glucuronide: a biomarker to identify alcohol use by health professionals recovering from substance use disorders. Alcohol Alcohol. Sep-Oct 2004;39(5):445-449.
  4. Kingdon JW. Agendas, alternatives, and public policies. Updated 2nd ed. Boston: Longman; 2011.
  5. Leape LL. Institute of Medicine medical error figures are not exaggerated. JAMA : the journal of the American Medical Association. Jul 5 2000;284(1):95-97.
  6. Schneidman B. The Philosophy of Rehabilitation for Impaired Physicians. The Federal Bulletin: The Journal of Medical Licensure and Discipline. 1995;82(3):125-127.
  7. Jansen M, Bell LB, Sucher MA, Stoehr JD. Detection of Alcohol Use in Monitored Aftercare Programs: A National Survey of State Physician Health Programs. Journal of Medical Licensure and Discipline. 2004;90(2):8-13
  8. Skipper G, Weinmann W, Wurst F. Ethylglucuronide (EtG): A New Marker to Detect Alcohol Use in Recovering Physicians. Journal of Medical Licensure and Discipline. 2004;90(2):14-17.
  9. McGarity TO, Wagner WE. Bending Science: How Special Interests Corrupt Public Health Research. Cambridge, MA: Harvard University Press; 2008.
  10. US Department of Health and Human Services. Mandatory guidelines and proposed revisions to mandatory guidelines for federal workplace drug testing programs: notices. Federal Register. April 13, 2004;69(71):19659-19660.
  11. Wood B. State of North Carolina Performance Audit North Carolina Physicians Health Program. . http://www.ncauditor.net/EPSWeb/Reports/Performance/PER-2013-8141.pdf. Accessed March 17, 2015.
  12. U.S. District Court Eastern District of Michigan, Case No: 2:15-cv-10337-AJT-RSW (2015). Carole Lucas, R.N., Tara Vialpandno, R.N., Scott Sanders, R.N., Kelly Schultz, P.A., and all other similarly situated health professionals v. Michigan Department of Licensing and Regulatory Affairs, Carole Engel, J.D.Former Director of Michigan Bureau of Health Professions, Ulliance, Inc. (State Contractor), Carolyn Batchelor (HPRP Contract Administrator), Stephen Batchelor (HPRP Contract Administrator), and Nikki Jones, LMSW.   Filed January 30, 2015.
  13. Boyd JW, Knight JR. Ethical and managerial considerations regarding state physician health programs. Journal of addiction medicine. Dec 2012;6(4):243-246.

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Rantings from the Bully Pulpit

 

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The three e-mails below were received within a twenty-four hour period from a physician supporting (and in all likelihood involved in) drug courts and physician health programs (PHPs).  E-mails such as this are invariably anonymous and I usually drag them right to the trash where they belong  but the trio below provides valuable insight into the mentality of those involved.  And for that reason I am posting them as they were received.

Under the nom de plume of “TT Wilson” the author presents non-sequitur and fallacious logic to promote drug courts, PHPs and the sanctification of an illegitimate  and irrational medical specialty.

He presents either/or logical fallacy and  false dichotomy.  You are either with us or against us!  He appeals to professionalism yet his words show he has no  inkling of the true definition, resorts to simple-minded cliches and meaningless platitudes and then sinks into ad hominem attacks on my blog and then me.

Ironically he accuses me me of ranting in a rant!

He is a prototypical example of the sham-artist physicians typically involved in these programs–an authoritarian paternalistic know-it-all who can only rant under the shield of gang-stalking power or a shroud of absolute anonymity.

As I have said time-and-time again if any factual errors exist in my blog I will not only remove them but remove my blog.

So I am going to make this offer to “TT Wilson”–if you wish to provide a rebuttal of any of the documentary evidence I provide in my blog herein then do so now.  If you can I will delete the whole kit and kaboodle.  Simple as that.

You Sir are an incompetent and a coward.  If not then prove me wrong. I challenge you to reveal your true identity. Let’s level the playing field a tad on this.  It is easy to present an opinion while cowardly hiding behind a veil of anonymity.  Let’s see if you have the courage to debate this publicly.

I won’t be holding my breath on this one.


 

February 7, 2015 7:45 PM

Comment:  It looks like it is too late already.  The ABAM is closer than ever to becoming a member of the ABMS, there is a big push from the Obama administration to fund addiction treatment and to greatly widen access.  As communities see how well run addiction programs save lives and force crime away from their homes the trend will be very hard to stop.  I agree, PHPs are draconian when they work with physicians thought to have SUDs, but I would rather have them too tough than too lax.  And a sober physician should be OK with that.

February 7, 2015  3:00 PM

Comment: Actually well run drug courts help patients who would have otherwise kept using substances of abuse.  Drug courts are quite dictatorial by design and clearly a defiant patient will defeat even the most caring and competent efforts to help them.  Of course we prefer that the patients be in a stage of change that leaves them open to treatment, but more than a few we’ve helped were not about to change without pressure from the court.

And I stipulated well run drug courts.  There are many incredibly poorly run drug courts.  When a judge doesn’t get it things are just as bad or worse than when the medical team doesn’t get it.  And the studies done are typically dismal.  Very short, small sample size, no standardization.  

As far as impaired physicians are concerned, it is not enough to just stop using and declare innocence.  If a cardinal event has attracted the attention of the medial (sic) board and that board requires participation in treatment to maintain licensure, well that goes with the license.  You can certainly choose not to participate, and the board can then choose to not let you practice.  They do the same thing with physicians with psychiatric issues.  And they encounter a huge amount of denial in this population, I would say more so than the lay population.  At least the denial is louder.

Dictatorial — sure.  Fair — well, no.  But life is not fair.  

As doctors we owe it to our patients to be held to a higher standard.  If someone of authority says I need to be screened, they are most welcome to any fluid or hair sample they require.  Is that fair?  Surely not.  Does that make it bad?  Not at all.

Do you have a better approach?  So far you haven’t demonstrated it in your myriad postings.

As far as ABAM is concerned, have you cried out about the ER boards, Pain Medicine boards, and all of the other boards that have been added to the charter members of the ABMS over the years?  Heck, back in the day a buddy of mine was grandfathered into the board of Plastic Surgery without even taking a test.  He sent them $500 and he was board certified.  Got a really nice certificate too, but it didn’t come with a frame.  Years later they started requiring fellowship training and actually taking a test.

I enjoy your site — clearly there are problems with the way care is being delivered by some individuals in some cases.  Of course that is true of every aspect of medicine.  No one is advocating that we shut down every other aspect of medicine.  Well some are, but that is for another discussion.  

My concern is that your ranting will deter some people away from meaningful treatment, very much like those who seethe against vaccinations lead the unknowing to not treat their children.  If I was cynical I could invoke Darwin here.  Thinning the herd.  

And you might want to get some help with wordpress.  This endless scrolling is distracting.  I was missing a good third of your content.

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February 7. 2015  9:45 PM

Comment: Finally made it to your last entry.  Please learn how to conduct a wordpress blog — your technique is very distracting.

You protesteth too much good sir.  Put aside your denial and get some treatment.  I am sure Harvard was glad to be rid of you.  They are very lucky you are out of there.

There might be some legitimate content in there somewhere, but by the time I reached the bottom of the page I was ready to hand you a mood disorder questionaire.  Not that we really need you to fill one out to make a diagnosis.

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Abuse Hidden Under a Veil of Benevolence: Bill Cosby, Physician Health Programs and Cognitive Dissonance

Fake ASAM ‘Doctors’ Push AA Cult For Profit.

The blue slides below are from a  presentation at the 2014 FSPHP spring meeting in Denver, Colorado and can be seen here.   The presentation was given by past FSPHP President Gary Carr, MD, Current FSPHP President Warren Prendergast, MD, West Virginia PHP Director Brad Hall, MD and Montana PHP Director Mike Ramirez, MS.

 

This needs to be seen as a "to-do" list.

This needs to be seen as a “to-do” list.

A.A. = ASAM = FSPHP 

The quote is from Alcoholics Anonymous and the full passage is as follows:

“We are convinced that a spiritual mode of living is a most powerful health restorative. We, who have recovered from serious drinking, are miracles of mental health. But we have seen remarkable transformations in our bodies. Hardly one of our crowd now shows any mark of dissipation.
      But this does not mean that we disregard human health measures. God has abundantly supplied this world with fine doctors, psychologists, and practitioners of various kinds. Do not hesitate to take your health problems to such persons. Most of them give freely of themselves, that their fellows may enjoy sound minds and bodies. Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward.”–Alcoholics Anonymous, 4th Edition,  The Family Afterward

Federation of State Physician Health Program (FSPHP) physicians often quote A.A. because they are defined by A.A. in both mechanics and mentality.  The “impaired physician” movement began with evangelical recovered addict and alcoholic physicians whose recovery was based on 12- step spirituality.  As this group molded into the American Society of Addiction Medicine (ASAM) many of them found employment at 12-step rehabilitation facilities and others joined their state Physician Health Programs and organized under the FSPHP.   Their ability to make authoritative pronouncements on physician impairment is  based on their own claim to insiders knowledge of recovery as brandished in this A.A. passage which I find condescending toward the medical profession and oddly narcissistic.

This special knowledge, of course, was based on the chronic relapsing brain disease model with lifelong abstinence and participation in 12-step recovery.

These “miracles of mental health” joined their state PHPs and those who did not agree with their rigid inflexible views were removed.   Those with access to special secret knowledge were eventually able to outvote those with intelligence and open minds as this groupthink infested and eventually monopolized  PHPs.


 

It is important to understand that the ideology of  A.A. is the ideology of the ASAM is the ideology of the FSPHP 

Like all “front-groups” the ASAM purports to serve one agenda while in reality serving another.  The ASAM claims to be a “physician society with a focus on addiction and its treatment” According to their website their mission is to

  • increase access to and improve the quality of addiction treatment;
  • to educate physicians (including medical and osteopathic students), other health care providers and the public;
  • to support research and prevention;
  • to promote the appropriate role of the physician in the care of patients with addiction;
  • and to establish addiction medicine as a specialty recognized by professional organizations, governments, physicians, purchasers and consumers of health care services, and the general public

In order to accomplish this the  American Board of Addiction Medicine certifies doctors  to “provide assurance to the American public that Addiction Medicine physicians have the knowledge and skills to prevent, recognize and treat addiction.”

Ostensibly these are laudable goals that are almost universally endorsed.   The perceived organizational purpose and public persona are altruistic and humanitarian.  Treating addiction not only saves individual lives but improves the community.  It is for the common good.


 

Abuse Hidden Under Benevolence and Torture as Treatment

History reveals that all manner of abuse can lie underneath a patina of benevolence.   In the past few months alone we have both Bill Cosby and the  British Parliamentary pedophile ring as prototypical examples.  Both cases reveal a decades long coverup of allegations in which the abusers escaped little or no investigation into their alleged crimes. Abuse of power with a large gap between the power of the abuser and the powerlessness of the abused is a common denominator.  If the abuser endorses our own beliefs systems it creates a discord that promotes disbelief.  It does not fit.   Accusations are dismissed, deflected or otherwise suppressed.   Power effectively extinguishes the truth.  Disbelieved and delegitimized, information is suppressed, charges are not filed and law enforcement and the media turn a blinkered eye for decades. Indifference, disbelief, rationalization and cognitive dissonance prevent exposure and accountability. Hidden in plain site the truth was there and easy to find.  The problem was no one was looking. Most did not want to look.

It does not take much sleuthing to uncover what is beneath the veil of the American Society of Addiction Medicine.  The history, mentality and mechanics are well documented and reveal where they came from,  how they evolved and what they have planned.    It is a complicated web and hard to explain but once the pieces of the puzzle are fit together it is clear.  But it involves assembling a complex puzzle by finding the individual pieces scattered in disparate areas including the regulatory, clinical, administrative and professional niches of the medical profession,  Alcoholics Anonymous and 12-step related organization, public policy, all levels of the political arena and other areas. Once put together the portrait is clear.

In reality the ASAM is a political action group or special interest group that is designed to cement the chronic relapsing brain disease model with lifelong abstinence and spiritual recovery as the one and only treatment for addiction.   A.A. is used as the energy source of the operation.  By labeling addiction a “disease” requiring “treatment” in which someone is helpless they are able to dictate all aspects by coercion and control.  But in my opinion the A.A. ideology is just used as a ruse to support the multi-billion dollar drug and alcohol testing, assessment and treatment industry.  The zero-tolerance mindset of the “treaters” combined with the “helplessness” of the diseased enables them to erect a revolving door of testing, assessment and treatment that provides them with both control and a steady stream of money.

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The FSPHP mandates 12-step ideology on all doctors in a zero-tolerance system of abuse and control while at the same time putting out misinformation that the PHP programs are the “new paradigm.”  The page below is from the book Drug-Impaired Professionals by Robert Holman Coombs.

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This is they type of propaganda these groups have propagated.   What is described above is absurd and unrealistic but it is reported, reproduced and repeated to the point that it is accepted as the truth.

The majority of physicians referred to these programs are not even addicts. These programs of Zero-tolerance and 12-step indoctrination are based on coercion and control.  They are causing many doctors to die by suicide as they are feeling hopeless, helpless and defeated.    This portrayal of a group of blissful 12-stepping doctors over the moon because they found spirituality is nonsense.

But you will not find many doctors speaking out against them for fear of “contingency management.”  Disagreeing or even questioning PHP practices including the validity of 12-step can literally cost you your license.

I have spoken to multiple physicians and nurses and have encouraged them to tell their stories here but they are afraid of retribution and “unintended consequences.”  And who can blame them?

They can send you back to one of the “PHP-approved” facilities for “stinkin thinkin.”

Unfortunately the ASAM and FSPHP have successfully bamboozled others into believing they are true experts with noble intent.  They have bamboozled the Federation of State Medical Boards (FSMB) to the point where they have gained autonomy and unrestrained managerial prerogative.    They essentially use the state Boards to impose sanction on doctors who they report doctors for “noncompliance” which includes disagreeing with or questioning mandated A.A  or refusing to admit you have a chronic relapsing brain disease when you in fact do not.    They are in fact imposing A.A. on doctors and forcing them to accept their thinking under threat of loss of licensure.  This  violates the Establishment Clause and is a very serious problem that is being ignored.  It is a slippery slope we are on.

The FSMB House of Delegates adopted an updated Policy on Physician Impairment at their 2011 annual meeting distinguishing “impairment” and “illness”  stating that Regulatory Agencies should recognize the PHP as their expert in all matters relating to licensed professionals with “potentially impairing illness” that predates impairment often by many years.”  

It also defines “relapse without use” as “behavior without chemical use that is suggestive of impending relapse.”Screen shot 2013-05-13 at 1.30.29 PM

G. Douglas Talbott defines  “relapse without use”  as  “emotional behavioral abnormalities” that often precede relapse or “in A. A. language –stinking thinking.”

The ASAM has  monopolized addiction treatment in the United States.  But what the FSPHP arm has done is far more sinister.   A.A. has effectively taken over regulatory medicine and the private lives of doctors as a form of social control.  A doctor can be referred to a PHP for virtually anything and if the PHP believes he or she is in need of an assessment it will be done by a “PHP-approved” facility which means it will be done by a 12-step facility.  The PHP selects who will be monitored and dictates every aspect of what that entails and the entire process is done within the confines of A.A. ideology.  It is a, in fact, a  rigged game as the medical directors of the PHP approved facilities can all be seen on this list of like-minded docs who refer to theselves as “trusted servants” and “believe that evidence from extensive, well-designed studies demonstrates the great benefits of Twelve-Step recovery modalities including Twelve Step Facilitation in promoting long-term recovery.”

A.A. is imposed  on doctors through the FSPHP.  The FSPHP political apparatus exerts a monopoly of force.    And the bottom line is that A.A. has taken over all aspects of “physician health” and is forcing doctors to accept doctrine that is perhaps helpful to a few, useless or unneeded for many, and harmful and sometimes lethal to others.  This is unacceptable and it needs to be recognized.


 

“New Paradigm” of Zero-Tolerance and 12-step Spirituality Based on “success” of PHP to Move to Other Occupations and Kids.

To move this “new paradigm” to other populations they had to gain control of the doctors first.  They have not only created a monopoly but buffered themselves from physicians who may disagree with what they are doing to others.  This current system essentially stifles them.

The power, immunity and impunity this group yields over doctors was done silently and with no opposition. It was done by sequential public-policy steps.  This is why anyone interested in civil liberties and human rights should recognize the menace this presents to society.   The scaffold is in place and they are just adding more nooses.  Just ask the airline pilots.  They plan to impose similar systems on teachers, students and athletes.

And this is all spelled out in the ASAM White Paper on Drug Testing.   What people need to realized is what is described therein is just a few public policy steps away from them.  The only organization they have to convince is the organization that regulates any type of professional license, employment or benefit.

Gaining regulatory sway in the medical field and control over individual doctors was necessary to move this model to other populations.  It is merely a stepping stone for things to come.  It is only a few public policy steps from us to you.

This impacts us all.   It enables control of research, public policy and public health.   It is a system that suppresses dissent and shapes conformity.  The FSPHP  encourages the confidential referral of outliers.

The ASAM is pro-drug war and anti-medical marijuana.  This essentially silences most doctors for fear of being recognized and being brought in.  I know many doctors who will not even talk about it in public.

This is fixed doctrine and will not change.

That is why the ACLU and other groups who promote civil rights, those who are against the drug war and anyone involved in Medical Marijuana need to step in.    These  groups need to recognize the reality of who these people are, what they have planned and understand why they need to be stopped.   They are currently not even in the public eye and by outward appearances they appear to be benign.   In truth they are malignant and rapidly metastasizing without any symptoms.

In Order to Stop This the Following Must be Done

1) get a team of epidemiologists/statisticians to attack the “evidence-base” and “research” that the ASAM/FSPHP has used to support their claims (junk science, pseudoscience, success of 12-step, etc) and do a Cochrane type meta-analysis that will show there is little to no basis for it.

2) Demand accountability of the PHPs. Assign accountability to the Medical Societies and Departments of Public Health. Demand they be accountable for state-contractors with the Medical Boards (many of whom are complicit–in Massachusetts the Board of Registration in Medicine is simply an extension of the state PHP-i.e. Like-minds.

3) Demand that the criminal activity taking place within these PHPs be addressed by law enforcement.

4) Demand the Attorney General enforce the rampant Establishment Clause Violations occurring with mass 12-step coercion.

5) Identify and expose the  backgrounds of many of the individuals involved including felons and double felons who reinvented themselves as “addiction medicine” doctors. Many of these individuals are repeat offenders with a history of manipulating the system who should have never had their licenses returned.  In my opinion the ASAM/FSPHP/LMD rigged system is an example of corporate psychopathy.  While corporate level psychopathy is estimated at around 3% the numbers here appear to be much higher if one looks at the moral disengagement, unethical decision making, lack of empathy and externalization of blame evident in their personal histories.

6) Correctly identify that this system of institutional injustice is responsible for the astronomical suicide rate in physicians. This is due to the fact that doctors who need help are not getting it for fear of being ensnared by the state PHP and those already ensnared are being subject to coercion, abuse, institutional injustice, degradation, dehumanization, delegitimization and civil and human rights abuses and that this is a public health emergency that needs to be addressed.

7) reveal the scam set up between the PHPs, rogue labs, and “PHP-preferred” assessment and treatment gulags.

8) show how this is only a few public policy steps from Doctors to Pilots to Teachers to students to kids. etc. etc.

This necessitates that we get the conversation going before it is too late.

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Integrity and Accountability—Defend the MRO Procedurally, Ethically or Legally and win 100 Volumes of the Classics in Medicine Library and Salk and Sabin Autographs!

Screen Shot 2015-06-18 at 11.46.50 PMIntegrity and Accountability—The Declining State of Physician Health and the Urgent Need for Ethical and Evidence-Based Leadership.

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Sabin and Salk Autographs

“The incompetent or unprincipled physician, licensed to practice medicine by a too complaisant State, is the greatest menace to scientific medicine – as great a menace as all the cultists put together.”  —Dr. Morris Fishbein  (The Medical Follies.  New York:  Boni Liverlight, 1925 p. 71)

“There is no place in science for consensus or opinion, only evidence”  —Claude Bernard


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Sabin, Salk and the Classics in Medicine Library

Polio is nearly a thing of the past thanks to to Dr. Jonas Salk and Albert Sabin. In 1952 Salk discovered and developed the first successful vaccine for polio and combined with Albert Sabin’s 1961 oral vaccination the duo effectively obliterated the contagious polio virus.  Once a deadly threat to our  country and future there were 93,000 cases of polio reported in the U.S. Between 1952 and 1953 alone. ElaineBurnsBut thanks to Sabin and Salk the last case of naturally occurring polio in the U.S. occurred in 1979.

 
full body respirator or “iron lung” needed to treat patients whose respiratory muscles became paralyzed by polio

October 23, 2014 was the centenary of Jonas Salk’s birth and in honor of his 100th birthday I am sponsoring a contest to win framed autographs of both Jonas Salk and Albert Sabin as seen above.  In addition,  you will receive 100 volumes of the Classics in Medicine Library published by Gryphon Editions whose “mission is the preservation of the literary and intellectual heritage of the noble professions that we serve”

These are exact facsimiles of the original classics bound in leather and include works by William Osler, Harvey Cushing and Paul Dudley White.

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Background

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

In this regard Dr. Wayne Gavryck, M.D. is a prototypical example.

An ex-alcoholic with a history of malpractice, Gavryck quit drinking through Alcoholics Anonymous, became “board certified” in “Addiction Medicine” and became involved with the Massachusetts PHP,  Physician Health Services, Inc. (PHS) where he has been an Associate Director since 1988.  He serves as their Medical Review Officer (MRO).

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The “impaired physician movement” has gained tremendous sway through the American Society of Addiction Medicine and the Federation of State Physician Health Programs.  The ASAM is not a valid medical specialty but a “special interest group” that represents the chronic relapsing brain disease with lifelong abstinence and 12-step recovery model of addiction and the companies that profit from it financially ( drug and alcohol testing labs,  12-step inpatient assessment and treatment centers) and politically  (Drug War advocates,  Anti -Medical Marijuana advocates).   The impaired physician movement gained a seat at the table of power in medicine by bamboozling regulatory and administrative medicine.   This illegitimate and irrational authority is in charge of almost every state PHP in the United States.     ASAM physicians joined their state PHPs, gained power, and then removed those who did not agree with the groupthink and doublethink.  Blind obedience and control  are favored over fairness, truth and evidence-base.   As with other states under the FSPHP, blindly obedient doctors are kept on while those who  question the science  and ethics of the groupthink are removed.  The  PHP-Drug Testing Laboratory and  “PHP approved” assessment and treatment center industrial complex requires a Medical Review Officer of blind faith who places the goals of the FSPHP above all other considerations including the Hippocratic Oath.  The system requires doctors who are willing to participate in “moral disengagement” of wrongdoing including professional, ethical and legal violations.    To erect this scaffold they have put in place barriers to exposure and accountability. By declaring themselves “experts” they have used logical fallacy to temporize  deflect and otherwise stifle accountability. With no oversight or regulation they are, in fact, accountable to no one.   The appeal to authority and esoteric knowledge is an effective means of  extinguishing valid concerns.  Complacent that this is a group of benevolent organizational purpose those who should know better and could do something about it rationalize their apathy and indifference.   A necessary step in exposing and addressing this  problem is imposing accountability.    If an organization is able to  engage in conduct that is the antithesis of accepted professional guidelines and standards of care,  in violation of professional and societal mores and codes-of-conduct and  is illegal then there is a systemic problem.  This problem can fortuitously be addressed by examining standards of care, conduct and criminal codes for breaches.   If a breach is found then it needs to be explained and justified.  One of the tactics of the FSPHP is to deflect criticism under the logical fallacy of appeal to authority.  We are the experts. We know better.  That is where it usually ends.   But accountability requires both the provision of information and justification of actions.  My hypothesis is that this group is committing fraud, violating ethics and flouting the law in an irrefutable manner.  If this is not true then my hypothesis should be able to be refuted.  It cannot.  And for that reason I am putting my money where my mouth is.


Accountability

In all fairness,  If Gavryck can justify his actions either procedurally, ethically or  legally and back it up by any written protocol, guideline or standard then he wins and I will refrain from any more criticisms.  In addition I will hand deliver to him the Salk and Sabin autographs and 100 volumes of the classics in medicine, apologize and remove this entire blog.

Accountability requires both the provision of information and justification of actions.  One way of examining this is to look at the body professional and ethical standards and state and federal law.   The FSPHP has blocked the provision of information regarding drug-testing.  Although it has taken over three years I have obtained the all of the information pertaining to a July 1, 2011  test that should have immediately been rejected by the MRO. It is an invalid test.

Dr. Gavryck violated every conceivable procedural guideline and standard-of-care there is for an MRO,  the Medical Review Officer Certification Council’s Codes of Ethical Conduct and both State and Federal Law.   This can be ascertained by looking at the documentation.  I have done this and found hundreds of documents that support the accusation that as an MRO Wayne Gavryck breached protocol, engaged in unethical behavior and broke the law.  Prove me otherwise with just one credible source and  the prizes are yours.

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Contest Rules

Your job is to review the documentary evidence and records from PHS, Quest Diagnostics and USDTL and assess the actions and decisions made by the MRO.S)

If you can show that  these decisions were the result of  legitimate reasoning based on published guidelines or protocol, ethically defensible or did not break any laws and cite one credible source that concurs with this point of view then you have won.

If you can show that these decisions were the product of legitimate and thoughtful reasoning in accordance with established guideline, ethical codes then I will hand-deliver the items to you.

 If you can justify, support or defend the actions of the Medical Review Officer (MRO):

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  2. Ethically; 

  3. or Legally;IMG_0577 - Version 2 

You win all of the prizes! Simple as that!

In fact, If you can support  just one of these the entire lot is yours.

If you can show Dr. Gavryck did not breach any and all published Standards-of-Care and Professional Protocols and Guidelines regarding drugs-of-abuse testing, OR that he did not violate any and all Codes of Conduct and Ethical Guidelines of the Medical Profession from Hippocrates to the American Medical Association OR that he did not violate multiple State and Federal Laws you win Salk and Sabin autographs and all of the books.

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All of the documents and details regarding the forensic fraud, concealment, coverup and deliberate misrepresentation to a state agency under color of law can be seen here:

Integrity and Accountability—The Declining State of Physician Health and the Urgent Need for Ethical and Evidence-Based Leadership.

To Review:   Any and all drug testing requires chain-of-custody.   “Forensic” drug testing differs from “clinical”drug testing because the consequences of a falsely positive test can be grave and far reaching.  Because the results of  a positive test can result in the loss of rights and liberties of the person taking the test it is essential that it be done correctly.  False-positive tests are unacceptable so strict chain-of-custody procedure and MRO review assure specimen integrity.    This provides accountability and the custody

The custody-and-control form records chain-of-custody and is given the status of a legal document as it has the ability to invalidate a test that lacks complete information.  The job of the MRO is to invalidate specimens without intact chain-of-custody.

The MRO job is fairly simple.  If a lab reports a positive test for any substance the MRO must check that the signatures, dates, times and other information on the custody-and-control form are correct and per protocol.  Chain-of-custody must be accurate and complete.   The MRO looks for “fatal flaws” on the chain-of-custody form.  If a “fatal flaw is present then the test is invalidated and the test is not reported as “positive” but “invalid.”

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The sole  job of the MRO is to ensure that the drug testing process and chain-of-custody procedure is followed to the letter.  The MRO reviews the Custody and Control form for accuracy and completeness.  The MRO also rules out any other possible explanations for a positive test (such as legitimately prescribed medications).  Only then is a test reported as positive.

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The legal issues involved in forensic testing mandate MRO review. According to The Medical Review Officer Manual for Federal Workplace Drug Testing Programs

“the sole responsibility of the MRO is to”ensure that his or her involvement in the review and interpretation of results is consistent with the regulations and will be forensically and scientifically supportable.”

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Corruption is misuse of entrusted power.  It occurs when those who have been given authority to carry out expected goals instead use their position and power to benefit themselves and others close to them. Abuse of power is particularly egregious when that person is doing the opposite of what he or she is supposed to do.

Accountability is necessary to prevent corruption and necessitates both the provision of information and justification for actions;  what was done and why?   The other defining factor of accountability is the ability of outside actors to punish and sanction those who commit misconduct or wrongdoing.    Without these constraints corruption is inevitable.

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Although Gavryck may serve PHS, it is not in the capacity of a certified medical review officer; by my count  the documentary evidence alone shows that he violated four of the seven Medical Review Officer Certification Council Codes of Ethical Conduct.  In addition to violating the MRO  Ethical Conduct he violated every other code I can think of from the Hippocratic Oath to the AMA Code of Ethics. and everything in between.

As the MRO for PHS Gavryck’s responsibility is simple.  He is supposed to verify that the chain-of-custody  of the sample was intact before reporting a test as positive.

This is indefensible on all levels (procedurally, ethically and legally). The documents show with clarity that this was not accident or oversight, but intentional and purposeful misconduct

There should be zero-tolerance for forensic fraud of this sort.   Those of integrity and moral compass would agree.     Transparency, regulation, and accountability are necessary.  It is an issue that needs to be acknowledged and addressed not ignored and covered up.

If Dr. Gavryck can give a procedural, ethical, or legal explanation of what was done then I stand corrected. Just one will suffice. If he cannot then this needs to be addressed openly and publicly.   And whether he was involved in the original fraud or not is irrelevant. As the MRO for PHS it is his responsibility to correct it–however late the hour may be.

Perhaps Dr. Gavryck needs to see some of the damage he has caused in order to take this responsibility. Known as a “bag man” who simply rubber stamps positive tests at the request of Linda Bresnahan, much like Annie Dookhan, he does not see the damage that is caused. Forensic fraud has grave and far reaching effects and in this case has severely impacted many people and include patient deaths. Perhaps Dr. Gavryck needs to take a “moral inventory” and see that this this type of behavior causes real damage to real people and put a face on it.

Please help me get this exposed, corrected, and rectified. The physicians of Massachusetts deserve better than this.

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Disrupted Physician 101.1: The “Impaired Physician Movement” and the History of the American Society of Addiction Medicine (ASAM)

Disrupted Physician 101.1: The “Impaired Physician Movement” and the History of the American Society of Addiction Medicine (ASAM).

Henry David Thoreau

“With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world.”—Twelve Steps and Twelve Traditions, AA World Services, Inc (1953).

In 1985 the British sociologist G. V. Stimson wrote:

“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.”

The American Society of Addiction Medicine’s mission is to “establish addiction medicine as a specialty recognized by professional organizations, governments, physicians, purchasers, and consumers of health care products, and the general public.”  

In this they have succeeded.images-4

And in the year 2014 Stimson’s characterization of the “impaired physician movement” remains as accurate and apt as it was in 1985. But the “number of evangelical recovered alcoholic and addict physicians” has increased dramatically  (outnumbering Addiction Psychiatry by 4:1)  and their involvement in  medical society and treatment programs” has been realized and enforced through the state Physician Health Programs and their “PHP-approved’ assessment and treatment centers.

Their “ability to make authoritative pronouncements on physician impairment…based on their own claim to insider’s knowledge”  has become public policy and sanctified by Regulatory Medicine -essentially the Word of the Lord.

And the 1953 Alcoholics Anonymous prophecy that “With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world” is also coming to pass.

But the world is not changing for the better as that arm around the shoulder of religion has its fingers deep in the pockets of the multi-billion dollar drug and alcohol testing and assessment and treatment industries.  And the arm around the shoulder of medicine has its fingers clamped tightly around its throat; a stranglehold in full throttle suffocating the Profession of Medicine with no meaningful opposition I can see.

Physician Health Programs:  The Need for Integrity and Accountability of Organizations

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Accountability, or answerability,  is necessary to prevent abuse and corruption.  This requires both the provision of information and justification for actions.  What was done and why?

Professional guidelines and standards of care, ethical codes of conduct and the law are all objective benchmarks that can be used to assess the actions and decisions of others.  In any free society this necessitates the existence of organizations of truly independent opinion capable of standing in this judgment.

State PHPs are Non-Governmental Organizations (NGOs) over which the state health department has no supervisory oversight.  There is no regulation, no transparency and no accountability.  There is no public scrutiny and they police themselves.

In Ethical and Managerial Considerations Regarding State Physician Health Programs Drs. John Knight and J. Wesley Boyd call for greater oversight and scrutiny of PHPs by the medical community at large.   They recommended periodic auditing, national standards and regulation.  They also attempted to convince the Massachusetts Medical Society to implement changes at PHS where they served as Associate Directors with over two decades of collective experience.

These efforts to promote transparency and accountability at both local and national levels, however,  fell on deaf ears.

State PHPs have systematically removed those not conforming to groupthink.  Threatening them with litigation if they breached “peer-review” statutes and confidentiality agreements has effectively silenced them from reporting any misconduct, abuse or even crimes they may have witnessed.

In Massachusetts John Knight was removed in 2009 and J. Wesley Boyd in 2010.  In Ethical and Managerial Considerations Regarding State Physician Health Programs  they comment “if a PHP highlights a physician as particularly problematic, the evaluation center might–whether consciously or otherwisetailor its diagnosis and recommendations in a way that will support the PHP’s impression of that physician.”  So too will the clinical laboratories.  

How is this any different from the case of Dr. Farid Fata, the Michigan oncologist who intentionally diagnosed healthy patients with cancer so he could charge them for unneeded chemotherapy?  The U.S. Attorney called it the “most egregious” case of health care fraud ever. His acts may have contributed to one patient death.   The institutional injustice of the PHP system is causing countless deaths of physicians.

To consciously “tailor” a diagnosis is fraud.  To tailor a diagnosis of substance use disorder or any other psychiatric diagnosis is the political abuse of psychiatry.  Misrepresentation, dishonesty, deception, and distortion play no role in the Profession and Guild of Medicine.  To do so violates the basic moral principles of Medical Ethics–Autonomy, Beneficence, Non-Maleficence and Justice.

The “PHP-approved” assessment and treatment centers are all staffed by doctors of “like-mind.”  It is a rigged game.

An audit of the North Carolina PHP found essentially no oversight from the Medical Board or Medical Society.  The audit found that “abuse could occur without being detected,” and this is by design.  By removing and blocking the provision of information necessary for accountability, restricting the liberties and freedoms of physicians, and increasing their power and control they have erected a framework of hidden abuse.

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The situation in North Carolina is standard operating procedure for PHPs under the Federation of State Physician Health Programs (FSPHP).  It is not the exception but the rule.

While outspoken in denouncing what they regard as unethical and unprofessional behavior by other doctors, they are resistant to apply even the most minimal standards to their own activities.

To whom are the PHPs accountable? Whom do they represent? There are legitimate concerns.

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Three shells and a pea–ASAM, FSPHP, and LMD

Unknown-3She likes a rigged game, you know what I mean?”

— R.P. Murphy in Ken Kesey’s One Flew Over the Cuckoo’s Nest

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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.

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.Screen Shot 2014-03-15 at 7.33.14 PM

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.

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?

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