Dr. Oliver Sacks: Disruptive Physician

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The article below regarding one of my personal hero’s Dr.  Oliver Sacks was published  by my friend Dr. Bharani Padmanabhanm in the Valley Patriot Ledger.  Thank God the current inept and illegitimate regime was not in place during Dr. Sacks’ formative years. His sympathetic and disruptive brilliance would have surely been snuffed out at its inception.  How many Oliver Sacks are we  losing today?  One can only wonder.


Choose Dr. Oliver Sacks over Lucian Leape or Alice Newton

By: Dr. Bharani PadmanabhanSept. 2015

Bharani-PadmanabhanDr. Oliver Sacks passed away last week from melanoma of the eye. He was best known for awakening people frozen into catatonic parkinsonism by the Spanish Flu and forgotten at the Beth Abraham Home for the Incurables. All they needed to awaken into normal life was a bit of levodopa. It was Dr. Sacks who thought of it and put his professional life on the line to give it to them. If you haven’t seen “Awakenings” yet, the time is now.

Of course that wasn’t the first time he had gone out of his way for a patient. When a blind, paralyzed, terminally ill patient learned Dr. Sacks was an avid motorbiker, she expressed a wish to take one last ride with him along the twisties of Topanga Canyon (Cali 27). Dr. Sacks arrived one fine Sunday with 3 heavy bikers who all carried the patient out to Dr. Sacks’ bike and securely tied her in place to him and his bike. She loved the ride. Dr. Sacks was almost fired as a result for being “unprofessional” and “disruptive” but was saved by the patient’s staunch support.

That he was almost fired tells us all we need to know about those who occupy the higher rungs in medicine.

It wasn’t any better after he awakened the catatonic. “Professional” doctors from the big teaching hospitals, who had all condemned the patients as beneath their time, “publicly roasted” Dr. Sacks for proving they were uncaring wastes of space.

Things have gotten a million times worse thanks to Harvard’s Dr. Lucian Leape who has relentlessly campaigned against the likes of Dr. Sacks and through the American Medical Students Association has ensured future generations of American doctors will not be like Dr. Sacks.

Dr. Sacks represented everything Dr. Leape loathes and defames as “disruptive” – he cared totally about the individual patient, their lives, hopes, dreams, and humanity.
Unlike Dr. Leape, Dr. Sacks did not sit around telling other doctors that they killed 100,000 patients every year and that they needed to purchase expert consultancy from his LeapFrog Group.

Instead, he devoted his life to his patients and to reminding the general public that neurological patients were as human as us all, and sometimes a bit special. He loved it when they survived their deficits or excesses and thrived.

Never ever did Dr. Sacks look upon patients as a number or a means to an end, a stone upon which to step to falsely boost one’s “career.”

Meaning, he was never ever like Harvard’s Dr. Alice Newton, who crushes good families to build herself up as an expert in “medical child abuse” (whatever that is) without any evidence and even when the evidence clearly shows that the parents are loving and never harmed their child.
Harvard’s Dr. Alice Newton has finally been shown to be a total fraud three times in a row, first in the Justina Pelletier case, then the Wilson baby case and now this very week, in the Irish Nanny case.

In the real world, three times and you’re out is enforced, even in law. When it comes to Harvard teaching hospital doctors however, we can expect the law to be ignored.

After all, it is always the cold ambitious sociopathic fraud who climbs the ladder and receives the accolades, awards, research grants and gushing write-ups in the Globe. The kind that Ben Hecht termed “The Respectables.”

Dr. Sacks, as expected, had only 20 published papers to his name and none of the long list of awards “the Respectables” give each other. Other members of “The Respectables” did not fall over themselves to laud him to the stars. Her Majesty’s Sir Donald Berwick never called Dr. Sacks a fine doctor, for example, though Sir Donald gushed all over Dr. Vivek Murthy.

The people of Massachusetts would be well advised to choose the likes of Dr. Sacks over Dr. Leape or Dr. Newton for their own care or their loved ones’. Dr. Sacks’ own patients certainly did and remained under his care almost till the end of his life.

Choose a physician who lives for his or her patients, who values and celebrates individuals and their inalienable rights, someone who treats each individual as important, someone who is totally disruptive on behalf of his or her patient, someone totally your advocate.

The difference between Dr. Sacks and the standard teaching hospital variety could not be more stark.

Bharani Padmanabhan MD PhD is a neurologist who specializes in multiple sclerosis in the Boston area. scleroplex@gmail.com

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How False Constructs Come to Be Regarded As Irrefutable Truth: The “Disruptive Physician”, Addiction Medicine Specialists and the 21st Century Inquisition of Doctors–Let’s See if She Floats!

Screen Shot 2014-02-24 at 9.19.46 AM“This physician may be clinically competent; indeed, he may be technically superior. However, no one wants to refer patients to him. No one wants to assist him in surgery. He is the one who screams at nurses, belittles medical students and makes criticisms that go beyond the bounds of fair professional comment. However, he is not always loud. He can be the passive physician who will not answer the pager while on call, who does not show up at meetings and will not help find solutions to departmental problems. Indeed, this physician is not always male, but more often than not that seems to be the case.”

So begins “The Dreaded Task of Confronting Disruptive Physicians,” 1 a call to arms by Dr. Graeme M. Cunningham, M.D. (Fellow of the American Society of Addiction Medicine) published in the Journal of Medical Licensure and Discipline in 2004  (The official publication of the  Federation of State Medical Boards (FSMB)) that helped launch a new paradigm for all those concerned with the physician “who has long eluded regulatory action, even though his behavior may have posed a risk to patient care and created chaos in his workplace for a number of years.”1

These experiences lead us to the tentative conclusion that disruptive behavior, if not dealt with properly, is often the symptom of a greater underlying problem that will impede the safe practice of medicine. What may seem to be largely an annoyance could be a symptom, endangering patients. If identified early, disruptive physicians can be effectively treated and should be referred to appropriate programs for treatment.2

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The American Society of Addiction Medicine and Federation of State Physician Health Programs (PHPs) set forth definitions of disruptive behavior, rules of evidence and regulation and the administrative procedures by which suspected doctors were “evaluated” and removed from practice.3

Written by the PHP doctors for PHP doctors, the disruptive physician construct came to be regarded as irrefutable truth and contributed to the identification and removal of an undetermined number of medical doctors. Although there was a general belief in “disruptive physicians” at the time of this call to arms they were not regarded as evil or life threatening. Society did not fear them and hospital administration and regulatory medicine did not feel the need to hunt them down. There were many scholars who publicly doubted this epidemic of disruptive physicians at the time. That would soon change.

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On July 9, 2008 the Joint Commission became so concerned about “behaviors that undermine a culture of safety” that it issued a “Sentinel Event Alert” on the topic and developed a “Leadership Standard” requiring all hospitals to have a code of conduct as well as a process for managing disruptive and inappropriate behaviors.4-6

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In 2011 the Federation of State Medical Boards issued an updated “Policy on Physician Impairment” giving full authority to physician health programs in the evaluation, treatment and ultimate fate of these doctors. The  FSMB House of Delegates adopted an updated Policy on Physician Impairment at their 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.”

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According to the FSPHP, physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years.” The policy extends PHP authority to cover physical illnesses affecting cognitive, motor, or perceptive skills, disruptive physician behavior, and “process addiction” (compulsive gambling, compulsive spending, video gaming, and “workaholism”). It also defines “relapse without use” as “behavior without chemical use that is suggestive of impending relapse.”

From the mid 1980s until present day a confederacy of “authorities” calling themselves “addiction medicine” specialists assisted in identifying disruptive physicians. Shaping clinical and legal orthodoxy they set the standards that cooperating regulatory authorities could follow in criminalizing, persecuting and punishing heretics.imgres

Behavioral manifestations included not answering pages on time, untimely or illegible chart notes, being late for meetings and questioning hospital authority.   Disruptive physicians were blamed for everything—patient morbidity and mortality, increasing malpractice costs and decreased hospital revenue.

Using the nebulous “disruptive physician” label, anyone with a grudge or suspicious could accuse anyone of misbehavior, malice and mayhem.

Propaganda, threats, misinformation, guild assumed from the start, PHP oversight of disruptive physician persecution was standard.

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During the state PHP “disruptive physician” with-hunts the legal notion of crimen exceptum (an exceptional and most dangerous crime) allowed for the suspension of normal rules of evidence to punish the guilty.

Because of the nature of the enemy the evidentiary bar was lowered and any witness, no matter what his credentials, could report a doctor to the state PHP.

Belief in the seriousness of the situation rationalized cruelty.

Professional experts used lie-detector tests (polygraphs), non-validated neuropsychological instruments, and non-FDA approved drug and alcohol tests to confirm the accusations.   The accused often did not pass these tests due to “tailoring” the results to fit the PHPs wishes and often received positive biomarker tests due to the ubiquity of the chemicals tested for. Bananas, sauerkraut, bakers yeast, urinary tract infections and hand sanitizer were often the cause. False accusations, if exposed, were excused if they were a result of “zeal for the faith.”

The consequences of being branded a heretic by questioning the existence “disruptive physicians” essentially silenced any dissenting voices and the notion of crimen exceptum freed the consciences of those involved.

Sanctimony, feigned piety and hypocritical devoutness was used as justification.  After all–Torture and torment are a small price to pay when it comes to protecting the public and saving souls.

Through the “disruptive physician” trials clerics, “addiction medicine” specialists, psychologists, neuropsychologists, commercial drug-testing labs, assessment and rehabilitation facilities and lawyers used their expertise as witnesses to increase their prestige.   The “disruptive physician” developed into a means of economic profit.  Some gained a lot of money from the “disruptive physician”.  The accused doctor and his or her relatives paid out of pocket for those who worked the “disruptive physician” trials including those doing the testing, assessment and treatment.

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“Witch hunting,” wrote the historian Rossell Hope Robbins, “was self-sustaining and became a major trade, employing many people, all battening on the savings of the victims.” So too is hunting the “impaired,” “disruptive” and “aging” physician and the costs are usually paid by the accused.

Their property was lost to pay the revolving door of testing, assessment and treatment and those overseeing it raked in increasingly large sums of money as well as other reliable assets. A doctor accused could easily be ruined permanently.

In 1592 Father Cornelius Loos wrote:

“Wretched creatures are compelled by the severity of the torture to confess things they have never done and so by cruel butchery innocent lives are taken; and by new alchemy, gold and silver are coined from human blood.”

And in 2015 nothing has changed.

Context, characters and circumstances may differ but the mechanics do not.

The mosaic remains the same.  

False constructs come to be regarded as irrefutable and the creation and chains of causation remain timeless

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  1. Cunningham GM. Editorial: The Dreaded Task of Confronting Disruptive Physicians. Journal of Medical Licensure and Discipline. 2004;90(2):6-7.
  2. Summer GL, Ford CV, Lightfood WM. The Disruptive Physician, I: The Alabama Physicians Recovery Network. Federation Bulletin. 1997;84(4):236-243.
  3. Bohigian GM, Bondurant R, Croughan J. The impaired and disruptive physician: the Missouri Physicians’ Health Program–an update (1995-2002). Journal of addictive diseases. 2005;24(1):13-23.
  4. Grenny J. Crucial conversations: the most potent force for eliminating disruptive behavior. Physician executive. Nov-Dec 2009;35(6):30-33.
  5. Huff DJ, Cline LE. Another reason to be on your best behavior: the Joint Commission’s new disruptive physician standard. Journal of the Medical Association of Georgia. 2009;98(2):17-18.
  6. Leiker M. Sentinel events, disruptive behavior, and medical staff codes of conduct. WMJ : official publication of the State Medical Society of Wisconsin. Sep 2009;108(6):333-334.Max-1


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“The belief that there are such things as witches is so essential a part of the faith that obstinately to maintain the opposite opinion manifestly savors of heresy.”  

So begins Malleus Maleficarum , a witch hunters manual published in 1486 that  launched a new paradigm for all those concerned with the identification and extirpation of witches.  Used as a judicial case-book the Malleus set forth definitions of witchcraft, rules of evidence, and the canonical procedures by which suspected witches were tortured and put to death.   Written by Inquisitors for Inquisitor, the Malleus construct came to be regarded as irrefutable truth and contributed to the identification and execution of as many as 60,000 “witches”, predominantly women.  The 29th and last edition was published in 1669.

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Although there was a general belief in witches at the time theas published they were not regarded as evil or life threatening.  Society did not fear them and Church and Political authority  certainly did not feel the need to hunt them down.   There were many scholars who publicly doubted the existence of witches at the time.  That would soon change.

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After being snubbed by secular and ecclesiastical authorities in his witch-hunting pursuits, the  Dominican friar and German Inquisitor Heinrich Kramer told Pope Innocent VIII of a  dangerous outbreak of witches that had occurred in the region.    This diabolical conspiracy hell-bent on destroying humanity needed to be identified and destroyed for the public good, but church authorities were not cooperating.

On December 5th, 1484 Pope Innocent VIII issued the papal bull Summis Desiderantes affectibus giving full authority to proceed with “correcting, imprisoning, punishing, and chastising” such persons “according to their deserts,”  and threatening to sanction or excommunicate those who hindered the pursuit.

images-18From the late 15th century through the early 17th century a confederacy of “authorities” calling themselves demonologists assisted in identifying witches. Shaping ecclesiastical orthodoxy they set the standards that cooperating political authorities could follow in criminalizing, persecuting and punishing heretics.

Behavioral manifestations  included living alone, cultivating strange herb and saying hello to a neighbors cat.Witches were blamed for everything—plague, crop failure, and erectile dysfunction.

Using the nebulous “witch label” anyone with a grudge or suspicion could accuse anyone of witchcraft .

Propaganda, threats, misinformation, guilt assumed from the start.

male31Physician oversight of witch persecution was standard.

During the European witch-hunts the  legal notion of crimen exceptum (an exceptional and most dangerous crime] allowed for the suspension of normal rules of evidence to punish the guilty.

Because of the nature of the enemy the evidentiary bar was lowered and any witness, no matter what his credentials, could testify against the accused.

Belief in the seriousness of the situation rationalized cruelty.

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The Devil’s mark (Stigmata diaboli) was taken as the mark of a witch entailing close inspection.

Professional witch-prickers used  needles, pins and bodkins to poke the skin with lack of bleeding confirming the accusation.   The accused did not bleed due to retractable needles and sleight of hand.   False accusations, if exposed, were excused if they were a result of “zeal for the faith.”

The consequences of being branded a heretic  by questioning the existence of witches essentially silenced any dissenting voices and the notion of crimen exceptum freed the consciences of those involved.

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Sanctimony, feigned piety and  hypocritical devoutness was used as justification.  After all–Torture and torment are a small price to pay when it comes to protecting the public and saving souls.

Through the witch trials clerics, doctors, and lawyers used their expertise as witnesses to increase their prestige.  Witch hunts developed into a means of economic profit.  Some gained a lot of money from the witch trials.  The witch or her relatives paid for the salaries of those who worked the witch trials including judges, court officials, torturers, physicians, clergymen, scribes, guards, attendants. Even the people who made the stakes and scaffolds for executions gained from the conviction and death of each witch.

matthew“Witch hunting,” wrote the historian Rossell Hope Robbins, “was self-sustaining and became a major trade, employing many people, all battening on the savings of the victims.”

The costs of a witch trial were usually paid for by the estate of the accused or their family.

Far from the conventional image of a penniless hag, a significant proportion of accused witches, especially in Germany, were wealthy and male.

Their property was seized to pay the clergymen, judges, physicians, torturers, guards, scribes, and laborers who raked in increasingly large sums of money as well as other reliable assets.

With a single member accused, a moderately wealthy family could be ruined permanently.

In 1592 Father Cornelius Loos wrote:

Wretched creatures are compelled by the severity of the torture to confess things they have never done and so by cruel butchery innocent lives are taken; and by new alchemy, gold and silver are coined from human blood.

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 Context, characters and circumstances may differ but the mechanics do not.

The mosaic remains the same.  

The Malleus shows how false constructs come to be regarded as irrefutable and the creation and chains of causation are timeless.

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The “Impaired Physician”–Increasing the grand scale of the hunt

“Wretched creatures are compelled by the severity of the torture to confess things they have never done and so by cruel butchery innocent lives are taken; and by new alchemy, gold and silver are coined from human blood.”  Father Cornelius Loos  ( 1592 )

 

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How Impaired Physicians Can be Helped–Medscape Business of Medicine Article Published February 24, 2015. Click on image to access

 

How can impaired Physicians be helped?

1.   Impairment among physicians is growing:  Why?  

Answer:  It is not.   State Physician Health Programs (PHPs) are “diagnosing” impairment when there is no impairment.  They are pathologizing the normal and expanding in scope to increase the grand scale of the hunt.

2.  What’s the Prognosis for Impaired Physicians?

Answer:  Not Good.   Those who need help (the truly impaired)  are afraid to get help for fear of being monitored by their state PHP while many of those ensnared by PHPs are not impaired.   There is absolutely no oversight, regulation or accountability.  This needs to be evaluated in the context of physician suicide.    The system is one of institutional injustice and abuse of power. 

3.  Is your knowledge of physician impairment up-to-date?  

Answer:   No.  This will only occur after an evidence-based Cochrane type review separates information from misinformation; An objective non-biased investigation by outside actors identifying any conflicts-of-interest, misconduct or lack of evidence-base in the current system and separating the art and science of the medical profession from the politicalization and exploitation of the medical profession.

The list of doctors on Like-Minded Docs  solves the final piece of a  puzzle. It explains why so many doctors across the country are claiming fabrication and manipulation of personality and cognitive tests to support nonexistent diagnoses at these “PHP-approved” assessment centers.    The relationship between the state PHP’s and the “PHP-approved” assessment centers is the same as it is between the state PHPs and the corrupt labs.

As Drs. John Knight and J. Wesley Boyd note in Ethical and Managerial Considerations Regarding State Physician Health Programs, published in the Journal of the American Society of Addiction Medicine,  this is what is known as “tailoring a diagnosis”–a euphemism for the political abuse of psychiatry.  According to the Global Initiative on Psychiatry “Political abuse of psychiatry refers to the misuse of psychiatric diagnosis, treatment and detention for the purposes of obstructing the fundamental human rights of certain individuals and groups in a given society.”   The shoe fits here.  In fact it fits very well.

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The Global Initiative on Psychiatry opposes the Political_Abuse_of_Psychiatry  wherever  it may occur and “supports those psychiatrists and psychiatric organizations that pressure the offending states to discontinue the practice and lobby vigorously those organizations which are wavering. The main way for individuals and organizations to work is through diplomatic channels. It is necessary to expose the practice and to embarrass countries that are at fault by expelling them from organizations such as the World Psychiatric Association. This can only be ensured by properly organized open investigation of psychiatric practice and interviews with the alleged victims”

Political abuse of psychiatry in the profession of medicine needs to be treated in the same way.

An evidence based Cochrane type assessment of their “research” and an Institute of Medicine Conflict of Interest review are long overdue.

In evaluating a physician for “impairment” or being “disruptive” the Physician Health Programs (PHPs)  under the Federation of State Physician Health Programs (FSPHP)  are not gathering data to form a hypothesis.  They are making data fit a hypothesis that arrived at the out-of-state “PHP-approved” assessment center well before the alleged miscreant doctor.

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, helplessness and despair.

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. 

The emperor has no clothes.

Sunshine is the best disinfectant.

https://artbylisabelle.wordpress.com/2015/03/01/three-shells-and-a-pea-asam-fsphp-and-lmd/

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Policy and Regulatory Decision Making in the Medical Profession: A Framework to Identify the influence of Special Interest Groups and “Bent” Science

content-1 In  Bending Science: How Special Interests Corrupt Public Health Research 1  Thomas McGarity and Wendy Wagner describe how special interest groups scheme to advance their own economic or ideological goals by using distorted or “bent” science to influence legal, regulatory and public health policy.

The authors describe a “separatist view” of science and policy that assumes scientific research is sufficiently reliable for public policy deliberations and legal proceedings when it reaches them.  This is illustrated as a pipeline in which it is presumed  the scientific community has properly vetted the information flow through rigorous peer-review and professional oversight.  The final product that exits the pipeline is understood to be unbiased and produced in accordance with the professional norms and procedures of science.   The reliability, integrity and validity of the final product is indubitably accepted.Screen Shot 2015-02-05 at 10.49.27 AMThe separatist  view does not consider the possibility that the scientific work exiting the pipeline could be intentionally shaped and contaminated by biasing influences as it flows through the pipeline.  When this occurs the final product exiting the pipeline is distorted or “bent” and bent science can result in bad decision making and bad policy.

Bent science starts with a pre-determined outcome and works backward from a desired result. It is not true science. Those orchestrating the deception (“benders”) use a variety of tactics and strategies to shape, package and spin science to support their own hidden agenda and suppress opposing science.

Benders attempt to hide, dismiss and debunk contrarian research and unsupportive science.  Benders will attack and harass the science and scientists that pose a threat to their interests. Using carefully crafted studies designed to confirm a desired outcome, the pre-determined conclusions are subsequently promoted and publicized to the relevant stakeholders who are often unable ( or sometimes unwilling) to discern real science from junk-science.

Misinformation, propaganda, and deception are disseminated in a variety of venues. Public relations firms are used to manipulate public perception and freelance writers are hired  brandish favorable consensus statements.  Authoritative reviews and critiques are ghostwritten under the names of  “outside experts” who profit both monetarily and by adding a high-profile publication to their resume.

Opinion is paraded as fact and with a dearth of professional oversight the charade usually goes unnoticed and unopposed.

Data-dredging, cherry picking, confirmatory bias, confirmatory distortion, fabrication, falsification, exaggeration, and a whole host of deceptive tactics are used to work backward from an already determined result.

Any information that contradicts the answer is manipulated, undermined, suppressed or downplayed; even if it is the result of real science and evidence-based research; even if it is the truth.  Professional procedure, protocol and ethics are off the table.  It is an underhanded free-for-all. Bare knuckle boxing. Trash your opponents work and label it junk-science. Undermine the integrity of your opponents.  Use ad hominem attacks to question the opponents motives. Claim the scientists are hacks on the take.  Start rumors about them. Screen Shot 2015-02-05 at 10.50.32 AM Loudly claim you are the one who is evidence based. Proclaim professionalism and authority.  Quibble. Move the goalpost.   Nit-pick and split hairs.  Proclaim over and over and over again you are the one who is evidence based.

And the problem is it usually works.  It is an unfair playing field.  When no meaningful barriers are in place to detect cheating and identify cheaters they usually win.

Bending science can have serious and sometimes horrific consequences and multiple examples including the Tobacco and pharmaceutical industry are given in the book.

Calling for immediate action  to reduce the role that bent science plays in regulatory and judicial decision making, the authors emphasize the assistance of the scientific community is necessary 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.”

But there are difficulties in challenging bent science including a general lack of recognition of the problem. With an absence of counter-studies to oppose deliberately manufactured ends-oriented research this would be expected.

Bent science involves the deliberate manufacturing of a pool of  information designed to promote a specific agenda.  A level playing field would require a pool of opposing research specifically addressing that agenda.  In reality this requires both the incentive and the power to do so–an unlikely scenario short of an equally well funded competitor or sufficient public concern about the problem.

In fact counter-forces are often nonexistent. Investigatory techniques developed and promoted by the FBI crime lab (such as firearms identification and intoxication testing) is one example described in the book.  These techniques evolved with little meaningful oversight from the larger scientific community and could be badly bent but there is no meaningful pool of information to disprove them.  The authors aptly state that   “defendants in most criminal cases lack resources to mount effective challenges, much less undertake their own counter-research.”

And part of the “art” of bending involves swaying public opinion and the mainstream media is typically aligned with the benders so opposing viewpoints seldom make the headlines.

Additionally, there is no meaningful oversight or avenue to pursue accountability. No systems exist to prevent, catch and publicly expose bent-science or those who bend science.

The influence of special interest groups on the practice of medicine is unknown.  No one has examined the role of bent science in the rules, regulations, policies and decisions made by those who are in charge of the standards of medical practice and professional behavior of doctors but as a regulated profession governed by the  decisions and policies of regulators it is certainly possible.

Regulation of the Medical Profession

Alexis de Toqueville once observed that a key feature of American government was the decentralized character of administration. “Written laws exist in America,” he wrote, “and one sees the daily execution of them; but although everything moves regularly, the mover can nowhere be discovered. The hand which directs the social machine is invisible.”2

Administrative law is the body of law that allows for the creation of public regulatory agencies and contains all of the statutes, judicial decisions and regulations that govern them. Administrative agencies implement their powers in the form of rules, regulations, orders and decisions.   State medical boards are the regulatory agencies responsible for the licensure and discipline of physicians. They grant the right to practice medicine in the form of a medical license and each state has Medical Practice Act that governs and defines the practice of medicine. The medical board is empowered to take action against a doctor for substandard care, unprofessional behavior and other violations as defined by the state Medical Practice Act.

Administrative Code governs the licensure and disciplinary process and the State Administrative Procedure Act governs the legal process (due process, discovery, etc.). Regulatory changes are enacted through procedural, interpretive and legislative rules.

Both medical practice acts and administrative procedure acts are subject to change.  Changes in medical practice acts can redefine what is acceptable practice and what constitutes professional behavior. This can increase the power and control these agencies have over doctors both professionally and socially.

Changes in Administrative practice acts can decrease what rights a doctor has if this power and control is abused.  Changes in the wording of administrative code and administrative practice acts can have profound implications in these rights including due-process, timeliness of being heard, rights to appeal decisions and time-constraints for judicial review.

And when these changes occur they do so silently.  The hand that directs the machine is indeed invisible.  The consequences, however, are not.  These changes not only impact those touched by the hand but can have a systemic impact on the entire profession.

State medical practice acts as well as administrative practice acts and code are susceptible to change and therefore susceptible to the influence of special interest groups benefitting from such change.  Regulation of the medical profession is thus susceptible to bent science.

Bent Science and the Medical Profession

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The impact of bent science on the regulation of the medical profession has not been studied. As a profession governed by regulatory agencies medicine is certainly not immune to the influence of special interest groups who could in turn influence public policy and regulatory decisions, rules and regulations to benefit their own interests.

Making sound decisions about regulation calls for an understanding of the problem it is intended to solve. This demands methodologically sound science and evidence-based facts arrived at through rigorous peer review and professional oversight. The science on which policy decisions are made must be reliable and unbiased. Legitimate policy must be based on recognized and legitimate institutions and experts.

If the information regulatory agencies rely on to discipline doctors and protect the public is unreliable then serious consequences can occur.

It would be beneficial to look for changes in public policy, guidelines, rules and regulations involving the medical profession and examine the reasons behind them. When did the problem present? Who presented it? Was it based on methodologically sound and accurate data?  What organizations do the problem presenters represent?  What organizations or individuals aligned or associated with the presenters might benefit?  What are the consequences?  Who is harmed?

Howard Becker describes the role of “moral entrepreneurs,” who crusade for making and enforcing rules that benefit their own interests by bringing them to the attention of the public and those in positions of power and authority under the guise of righting a society evil.8   

The mechanics and mentality is similar to the science benders and, as discussed below,  they use some of the same techniques.

Moral entrepreneurs take the lead in labeling a particular behavior deviant and spreading this label throughout society.  They associate the behavior of some group with a society evil, affix an easily recognizable label to it and then express the conviction that the evil must be combated.  Labeled as being outside the central core values of consensual society, the deviants in the designated group are perceived as posing a threat to both the values of society and society itself.

Activities can rise to the level of ‘social problems” when harm or danger is attributed to those activities and governmental powers are called upon to put an end to those harms. Bent science requires convincing others of a viewpoint and the likelihood of this occurring increases when the activity that is identified as a problem resonates with underlying societal concerns and anxieties.  The problem is then endorsed by experts who give legitimacy to such claims.3,4 This legitimacy results attracts media attention which further enforces support from both the public and policy makers.5,6  

As a result any bent science directed at regulatory and public policy decision making should be clearly visible.

The sociologist Stanley Cohen used the term ”moral panic” to characterize the amplification of deviance by the media, the public, and agents of social control.7 According to cultural theorist Stuart Hall, the media obtain their information from the primary definers of social reality in authoritative positions and amplify the perceived threat to the existing social order. The authorities then act to eliminate the threat.9 The dominant ideas or ideologies are reproduced by relying on the opinions of the defining authority and then spread through the media.

An internet search of what labels have been affixed to doctors in association with a threat to society there are three.  A google search of “impaired physician” yields 20, 600 results; “disruptive physician” yields 17, 400 results; and “aging physician” yields 27, 800 results. A large number of these articles, opinion pieces and reviews associate impaired, disruptive and aging physicians with patient death and other adverse events, medical error, and malpractice.   The labels affixed to these physicians have been characterized as a major threat to public health and the rhetorical tools used in many of these articles seems aimed at increasing public anxiety.

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A PubMed search yields 154 results for the “impaired physician”; 47 results for the “disruptive physician”; and 19 results for the “aging physician.”  Many of these are opinion pieces written by the same group of physicians and aimed at hospital administrators, regulators and those involved in the legal or business aspects of medicine.

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There is, in fact, no evidence based research that associates the impaired, disruptive or aging physician with any adverse events. The “impaired,” “disruptive” and “aging” physician labels  as evinced by a quick google search seem escalated far beyond the level warranted by the existing evidence.

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The “impaired” and “disruptive” labels have taken on the status of moral panic and the “aging” label, which is being associated with cognitive impairment, seems to be heading in that direction. The number of articles being published and lectures being given on the dangers of cognitively impaired doctors is increasing.  It has not yet reached the level of public awareness the impaired and disruptive have.

To acknowledge that the current level of concern about these labels is exaggerated is not to suggest they do not exist. They do.  But the disparity between the evidence-base, or lack thereof, and the level of concern warrants further investigation.

To be clear,  doctors who are impaired by drug and alcohol abuse need to be removed from practice to protect the public and receive treatment;  doctors who are abusive to others or engage in behavior that threatens patient care need to be held accountable for their actions; and doctors who are cognitively impaired due to dementia need to be removed from practice and evaluated by the proper specialists.  If a diagnosis of dementia is confirmed then they need to be removed from practice.

What is the motivation behind the “impaired,” “disruptive” and “aging” physician labels and the multiple articles linking these labels to patient harm and medical error?  There is no data driven evidence so where does it come from?   Could moral entrepreneurs be behind it?  If so then there should be evidence  of bent science and to examine this we must look for evidence that these labels have been used to influence regulatory decisions, rules, regulations and policy.

And with the recently archived Journal of Medical Regulation this task can be easily accomplished.

The Journal of Medical Regulation as Timeline and Framework for Policy Evaluation

The Federation of State Medical Boards (FSMB) is a national not-for profit organization that gives guidance to state medical boards through public policy development and recommendations on issues pertinent to medical regulation. Shortly after its founding in 1912, the Federation of State Medical Boards began publishing a quarterly journal addressing issues relating to medical licensing and regulation of doctors. First published in 1913 as the Quarterly of the Federation of State Boards of the United States, the publication has undergone several name changes and publication schedules. From1921 to 1999 it was published monthly as the Federation Bulletin. In 1999 it was changed to the quarterly Journal of Medical Licensure and Discipline and in 2010 was revised to the Journal of Medical Regulation The Journal of Medical Regulation is in the process of archiving all issues dating back to 1913.

Presently every paper dating back to 1967 is available online and the archival organization and availability of full articles published sequentially over the past half-century is historically invaluable.   As the official journal of the national organization involved in the medical licensing and regulation of doctors, this archival organization allows for an unskewed and impartial examination in both historical and cultural context. We can identify when particular issues and problems were presented, who presented them and how.

The Journal of Medical Regulation archives provides a structured context to examine these issues in their historical and cultural context.  This facilitates a retrospective analysis.  As a timeline it allows identification of when the issues were presented.  It also allows us to look at the events preceding the problem, who benefited from them, and the consequences. Could these factors be involved in influencing the regulation of medicine and shaping the medical profession? Could bent science have been involved in regulatory and administrative changes that have significantly impacted the rights and well-being of doctors and how the profession of medicine is defined?  Could some of the current problems such as the marked increase in physician suicide, sham-peer review, and physician burnout be the result of bent science?  If bent science is contributing to bad policy and bad decision making then it need to be exposed and addressed.  Bent science is bad medicine and if it exists then we need to urgently shine a light on it.

  1. McGarity TO, Wagner WE. Bending Science: How Special Interests Corrupt Public Health Research. Cambridge, MA: Harvard University Press; 2008.
  2. de Toqueville A. Democracy in America. New York: Penguin Books; 1984.
  3. Blumer H. Social Problems as Collective Behavior. Social Problems. 1971;18:298-306.
  4. Stone DA. Causal Stories and the formation of policy agendas. Political Science Quarterly. 1989;104:280-300.
  5. Best J. Threatened Children, Rhetoric and Concern about Child Victims. Chicago University of Chicago Press; 1990.
  1. Gerbner G, Gross L. The scarey World of TV’s heavy viewer. Psychology Today. 1976;9(89):41-45.
  2. Cohen S. Folk Devils and Moral Panics: The Creation of the Mods and Rockers (New Edition). Oxford, U.K.: Martin Robertson; 1980.
  3. Becker H. Outsiders: Studies in the Sociology of Deviance. New York: Free Press; 1963.
  4. Hall SC, Critcher C, Jefferson T, Clark J, Roberts B. Policing the Crisis: Mugging, the State, and Law and Order. London: Macmillan; 1978.

 

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