The Proposed Expansion of PHPs. Illegitimate and Irrational Authority and the Urgent need for a critical analysis of the “PHP-Blueprint”

“If you tell a lie big enough and keep repeating it, people will eventually come to believe it.” –Joseph Goebbels

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1. National Physician Health Program Blueprint Study Publications List

2.  Setting the Standard for Recovery: Physicians’ Health Programs


Physician Health Programs  (PHP) claimed “gold standard” for addiction treatment. “80% success rate” being used to promote “new paradigm” to other populations.

 PHPs are essentially Employee Assistance Programs (EAPs)  for doctors.  The vast majority of people know little or nothing about Physician Health Programs (PHPs).

Physician Health Programs (PHPs) are being called  the “gold-standard” for EAPs.    Claims of unparalleled success are being used to promote PHPs to other populations as a “replicable model of recovery.”

Drs. Robert Dupont and Gregory Skipper are promoting PHPs as “A New Paradigm for Long-Term Recovery”  claiming an 80% success rate in doctors.

An article entitled “What Might Have Saved Philip Seymour Hoffman,” claims PHPs “ought to be considered models for our citizenry” and the “best evidence-based addiction treatment system we have going.”   The author repeats the 80% success rate for doctors and claims Philip Seymour Hoffman might still be alive if he had been treated using the PHP model.

The basis for these claims is a 2009 study published in the Journal of Substance Abuse Treatment entitled  Setting the Standard for Recovery: Physicians’ Health Programs and authored by Robert Dupont,  A. Thomas McLellan,  William White, Lisa Merlo and Mark Gold.

This  study is the cornerstone of the “PHP-blueprint.” It is the very  foundation on which everything else is based, a Magnum opus used to lay claim to supremacy that has been endlessly repeated and rehashed in a plethora of self-promotion and treatment community blandishment.

To date there has been no academic analysis of the “PHP-Blueprint.”    There has been no Cochrane type analysis or critical review.    There has been no opposition to its findings or conclusions which are paraded as fact and truth without challenge or question and there is a general lack of concern from those both within and outside the medical profession.


The Expansion of Physician Health Programs (PHPs) to Other Populations

1.  Although these programs claim to help doctors they may actually be harming many and contributing to suicide.

2.  The plan is to greatly expand these programs to other populations and you could be next.

In 2012 Robert Dupont delivered the keynote speech at the Drug and Alcohol Testing Industry Association annual conference and described a “new paradigm” for addiction and substance abuse treatment and proposed expansion of this paradigm to other populations including workplace, healthcare, and schools.

It is therefore critical that the “PHP-blueprint” be examined using critical reasoning and evidence base.   All of this needs to be assessed in terms of legitimacy and intent.

Lack of Evidence-Base and Conflicts of Interest

A  cursory  analysis of the study on which this success rate is based reveals very little evidence base.

The claim of 80% success rate in physicians is based on Setting the Standard for Recovery: Physicians’ Health Programs is unfounded.  The study is a poorly designed using a single data set (a sample of 904 physician patients consecutively admitted to 16 state PHP’s).

It  is non-randomized and non-blinded rendering the evidence for effectiveness of the PHP treatment model over any other treatment model (including no treatment) poor from a scientific perspective.  The study contains multiple flaws in both reasoning (type I and type II errors) and statistical analysis that render its conclusions invalid.

In addition the impact of undeclared but substantial financial conflicts-of-interest (including funding by drug testing and addiction treatment industries) and personal ideological biases (including personal 12-step recovery from addictions) in the authors of this study also needs to be considered.

Moreover the misdiagnosis and over-diagnosis of addiction in physicians in this paradigm  incentivized by lucrative self-referral dollars for expensive 90-day treatment programs is a significant factor.

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False Endpoints and High Mortality Rate

The mean age of the 904 physicians was 44.1 years. They report that 24 of 102 physicians were transferred and lost to follow “left care with no apparent referral.”

What happened to them? These are physicians with multiple identifiers (state license, DEA, UPIN, etc) not transient drifters.

Of the 802 left in the program they report 155 failed to complete the contract. Of these, 48 involuntarily stopped or had their license revoked and 22 died with 6 of those being suicides.
This study is looking at defined endpoints while being monitored so 6 killed themselves while being actively monitored by the program. But what about the 24 that left with no apparent referral? It is unlikely the just left on a whim. There must have been some precipitant event.

More importantly what happened to those 48 who were reported to the Medical Board for noncompliance and had their licenses revoked–that would be the critical time when this population would be at most risk for completing a suicide. That would be when hope was lost and the coerced physician, knowing that the fight was over, would take that step.

The outcomes they used were the last reported status of the PHP participant enrolled in the program.   Measuring success of program completion in doctors compared to the general population is meaningless as the short-term outcomes are quite different in terms of the external consequences imposed.   The consequence of not completing a PHP is the invariably career ending.    So what happened to the 24 of who “left care with no apparent referral,” the 85 who “voluntarily stopped or retired,” and the 48 who “involuntarily stopped or license revoked.”

Whether you leave a PHP voluntarily, involuntarily, or with no apparent referral it is the end game and your career is over.  Comparing this to other populations where the consequences of failing to complete the program are not so final is inappropriate.     Claiming superiority over programs with a 40% success rate is unfounded because for most of those people the consequences are not so final and may mean nothing more than an increase in testing frequency.

The big question is what happened to the 157 physicians who left or stopped?  How many of them killed themselves. With an average age of 44 there were  6 reported suicides 22 deaths, and another 157 no longer doctors.  I would venture to say the number of suicides is a lot higher than they claim.  But using the last recorded PHP status as the final outcome obfuscates this.

Due to the severity of the consequences a 20% failure rate is quite concerning. This is of particular concern because many doctors (if not most) monitored by PHPs are not addicts.

Imposed 12-step ideology and use of non-FDA Approved Drug and Alcohol Testing

As noted above, PHPs are essentially Employee Assistance Programs (EAPs)  for doctors. Most EAPs, however, were developed in the presence of trade unions and other organizations working on behalf of the best interests of the employee. This collaborative effort led to EAPs that were more or less “organizationally just” with procedural fairness and transparency.

No such organizations exist for doctors.   Due to the absence of oversight and accountability  PHPs have been able to use non-FDA approved laboratory developed tests of unknown validity on doctors without any opposition.Screen Shot 2015-06-26 at 6.49.16 AM

The distinction between professional and private life as a fundamental value of our society  and the importance of this boundary was also upheld by these groups.

In the PHP paradigm no procedural fairness or transparency exists and the boundary between professional and private life has eroded.

PHPs impose 12-step ideology on all doctors referred to these programs.   State Medical Boards  enforce this in violation of the Establishment Clause of the 1st Amendment yet there is little recourse for doctors as they are threatened with non-compliance and loss of licensure.

Selling the PHP Paradigm

The use of 12-step  is most likely not ideologically driven but profit driven. Abstinence based 12-step programs justify the use of frequent drug and alcohol testing with ongoing lifelong assessment and treatment.    As with drug-courts,  PHPs provide a lucrative model to the drug and alcohol testing, assessment and treatment industry.

The plan to expand this to other populations is outlined in the ASAM White Paper.

This concerns all of us.  The first step needs to be a critical appraisal of  Setting the Standard for Recovery: Physicians’ Health Programs,  the foundation of their claims of an 80% success rate and a conflict-of-interest analysis of its authors.  The legitimacy of the study and its claims needs to be questioned.

It does not take a Cochrane review to see that the emperor has no clothes.  This is not difficult. It is straightforward and simple.

Screen Shot 2015-06-26 at 6.30.41 AM  As an illegitimate and irrational authority it is necessary that this opinion remain unchallenged. We need to challenge it.

Historical, political, economic and social analysis reveals that the “PHP-blueprint” is a false-construct built on circumnavigation and obfuscation.  An evidence-based scrutiny of the literature would reveal it to be invalid and of little probative value.

But if  nobody speaks up it is inevitable that they will expand the “PHP blueprint”  to other employee assistance programs and schools.

This is not just about doctors.  You too are at risk for coercion, control, conformity and forced adherence to a  lifetime of abstinence and 12-step indoctrination and if you do not speak up now it won’t be a risk but a certainty.

“Addiction Medicine” is not recognized by the American Board of Medical Specialties (ABMS)–It is a “self-designated-practice specialty” (SDPS) and indicates neither knowledge nor expertise.

V0011377 A quack doctor selling remedies from his caravan; satirizingEducational and Professional Standards in Medical Specialties and Subspecialties

The increasingly rapid growth and complexity of medical knowledge in twentieth century American medicine resulted in the creation of specialties and subspecialties.

A related development was the creation of “boards”  to “certify” physicians as  knowledgeable and competent in the specialties and subspecialties in which they claimed to have expertise.   The American Board of Ophthalmology, organized in 1917, was the first of these.

As the number of medical specialties proliferated an umbrella organization was formed to accomplish this task. The Advisory Board for Medical Specialties was created  in 1933 and reorganized as the American Board of Medical Specialties (ABMS) in 1970.  This non-profit organization oversees board certification of all physician specialists and sub-specialists in the United States.

The ABMS recognizes 24 medical specialties in which physicians can pursue additional training and education to pursue Board Certification.Screen Shot 2014-11-07 at 7.44.56 PM

In 1991 the American Board of Medical Genetics was approved as the 24th ABMS board and these 24 boards grant the  37 general certificates and 88 subspecialty certificates available to medical specialists today.

The ABMS Member Boards are responsible for developing and implementing the educational and professional standards for quality practice in a particular medical specialty or subspecialty and evaluate physician candidates for Board Certification.  They set the bar of knowledge and competence for their given area of expertise.

All of the ABMS Member Boards are:

“committed to the principle of examining doctors based on six general competencies designed to encompass quality care: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.”

These areas have been collectively identified by the ABMS, the American College of Graduate Medical Education (ACGME) and the Institute of Medicine (IOM) in order to standardize graduate medical education in any specialty  from medical school graduation through retirement.1

One of the  24 medical specialties ABMS recognizes in which physicians can pursue additional training and education and pursue Board Certification is Psychiatry.

Founded in 1934, The American Board of Psychiatry and Neurology (ABPN) is one of the 24 ABMS specialty boards. In 1959, the ABPN issued its first subspecialty certificate in Child and Adolescent Psychiatry and was the only ABNP subspecialty until 1991 when the first examination in Geriatric Psychiatry was administered.4 Addiction Psychiatry became a subspecialty of ABPN in 1993.

The ABPN governs the specialty of Psychiatry, of which Addiction Psychiatry is a subspecialty.   Board Certification in Addiction Psychiatry requires a four-year psychiatric-residency program for training in the prevention, diagnosis and treatment of mood, anxiety, substance-abuse as well as other psychological and interpersonal problems followed by an additional year of training in one of the 40 accredited Addiction Psychiatry Fellowship programs. The Accreditation Council for Graduate Medical Education (ACGME) is the professional organization responsible for the accreditation residency education programs in the US for ABMS specialty and subspecialty areas of medicine. Addiction Psychiatry training programs are governed by the ACGME and graduates are eligible for ABPN Certification in Addiction Psychiatry.

When this rigorous education and training is complete a candidate is Board Eligible and can then take the subspecialty certification exam. The exam assesses competency in the dand consultation, pharmacotherapy, pharmacology of drugs, psychosocial treatment and behavioral basis of practice to be Board Certified in the subspecialty of Addiction Psychiatry by the ABPN.

Candidates must then be assessed in  a number of areas including psychiatric evaluation and consultation, pharmacotherapy, pharmacology, toxicology, psychosocial treatment, behavioral basis of practice, and many other areas in which for the past half-decade they where taught and apprenticed.

The current structure of residency training is little changed from when it was conceived originally by William Stewart Halsted in the late 19th Century.  Physicians acquire knowledge and skills necessary to safely and competently manage patients through apprenticeship. Training in a specialty area provides a comprehensive platform that allows medical school graduates to apply a body of knowledge to patient care and the treatment of disease. This forms the foundation of our Guild–undifferentiated and general but pluripotential.

The American Academy of Addiction Psychiatry (AAAP) is the only professional organization in the US focused on the subspecialty of Addiction Psychiatry.   The AAAP Mission Statements are to: 2

  • PROMOTE HIGH QUALITY EVIDENCE-BASED SCREENING, ASSESSMENT AND TREATMENT FOR SUBSTANCE USE AND CO-OCCURRING MENTAL DISORDERS.
  • TRANSLATE AND DISSEMINATE EVIDENCE-BASED RESEARCH TO CLINICAL PRACTICE AND PUBLIC POLICY.
  • STRENGTHEN ADDICTION PSYCHIATRY SPECIALTY TRAINING AND FOSTER CAREERS IN ADDICTION PSYCHIATRY.
  • PROVIDE EVIDENCE-BASED ADDICTION EDUCATION TO HEALTH CARE TRAINEES AND HEALTH PROFESSIONALS TO ENHANCE PATIENT CARE AND PROMOTE RECOVERY.
  • EDUCATE THE PUBLIC AND INFLUENCE PUBLIC POLICY FOR THE SAFE AND HUMANE TREATMENT OF THOSE WITH SUBSTANCE USE DISORDERS.
  • PROMOTE PREVENTION AND ENHANCE ADDICTION TREATMENT AND RECOVERY ACROSS THE LIFE SPAN.
  • PROMOTE RESEARCH ON THE ETIOLOGY, PREVENTION, IDENTIFICATION AND TREATMENT OF SUBSTANCE USE AND RELATED DISORDERS.

Self-Designated Practice Specialty :  An AMA Census Term Indicating What a Group of Doctors are Calling Themselves.

Screen Shot 2014-03-18 at 5.22.16 PMThe American Medical Association records a physician’s Self-Designated Practice Specialty (SDPS) in response to an annual credentialing survey. According to the AMA, SDPS are “historically related to the record-keeping needs of the American Medical Association and do not imply ‘recognition’ or ‘endorsement’ of any field of medical practice by the Association. SDPS refers to a self-designated specialty and this is not equivalent nor does it imply ABMS [American Board of Medical Specialties] Board Certification.a_meissen_group_of_harlequin_and_the_quack_doctor_circa_1741_faint_blu_d5585085_001h

“The fact that a physician chooses to designate a given specialty/area of practice on our records does not necessarily mean that the physician has been trained or has special competence to practice the SDPS.”3

Physicians have been able to list addiction medicine as a self-designated area of practice using the specialty code “ADM” since 1990.Screen Shot 2014-11-07 at 7.45.43 PM

In contrast to these accepted board credentials, American Board of Addiction Medicine (ABAM)  certification requires only a medical degree, a valid license to practice medicine, completion of a residency training in ANY specialty, and one year‘s full time involvement plus 50 additional hours of medical education in the field of alcoholism and other drug dependencies. The majority of American Society of Addiction Medicine (ASAM) physicians meet these requirements by “working in a chemical dependency treatment facility, taking continuing medical education courses in addiction, or participating in research.”6

The American Society of Addiction Medicine’s mission is to “establishScreen Shot 2014-11-07 at 7.47.55 PM addiction medicine as a specialty recognized by professional organizations, governments,, physicians, purchasers, and consumers of health care products, and the general public.’5   They have succeeded in doing this as many consider them to be the experts in addiction medicine including regulatory agencies.

The goal of the American Board of Addiction Medicine (ABAM) Foundation is to “gain recognition of Addiction Medicine as a medical specialty by the American Board of Medical Specialties (ABMS).”

But Addiction Medicine is currently not recognized by the ABMS.  It is still a a Self-Designated Practice Specialty and the ABAM is a Self-Designated Board.  So too is the American Academy of Ringside Medicine and Surgery, the American Academy of Bloodless Medicine and Surgery and the Council of Non-Board Certified Physicians.   But these Self-Designated Boards do not have the multi-billion dollar drug and alcohol testing and treatment industry supporting them. Addiction Medicine has deep pockets, and if the November 2014 issue of the Journal of the American Medical Association (JAMA) is a harbinger of what’s to come, this self-designated practice specialty currently being certified by a self-designated Board and bereft of anything resembling the the educational and professional standards for quality practice in a particular medical specialty or subspecialty may soon robber baron its way into acceptance by the American Board of Medical Specialties.

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One thing is for certain.  When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model.  The birth of Addiction Medicine as an ABMS accepted discipline is sure to be a success for the drug and alcohol testing and 12-step treatment industry, but its spawn is sure to be an inauspicious mark on the Profession and Guild of Medicine and a bane of society for years to come.

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  1. Stevens RA. In: Stevens R, Rosenberg C, Burns L, eds. History and Health Policy in the United States: Putting the Past Back in: Rutgers University Press; 2006:49-83.
  2. American Association of Addiction Psychiatry Website http://www.aaap.org/about-aaap/mission-statement (accessed 4/2/2014).
  3. American Medical Association. List & Definitions of Self-Designated Practice Specialties. August 21, 2012 http://www.ama-assn.org/ama.
  4. Juul D, Scheiber SC, Kramer TA. Subspecialty certification by the American Board of Psychiatry and Neurology. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry. Spring 2004;28(1):12-17.
  5. http://www.asam.org/about-us/mission-and-goals.
  6. Tontchev GV, Housel TR, Callahan JF, Kunz KB, Miller MM, Blondell RD. Specialized training on addictions for physicians in the United States. Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse. Apr 2011;32(2):84-92.
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“mail order” expertise; Diploma Mill

Drug Companies and Doctors: A Story of Corruption

Drug Companies and Doctors: A Story of Corruption.

What we need is a Marcia Angell to take on the multi-billion dollar drug and alcohol testing, assessment and treatment industry.

Screen Shot 2015-06-01 at 7.22.25 PMWhile all eyes were focused on the drug companies these multi-billion dollar industries erected a scaffold of immunity and profit by removing (and blocking) themselves from essentially all aspects of accountability; answerability, justification for actions and the ability to be punished by outside actors.    The 2009 quote in reference to “big pharma”  is just as applicable to the drug and alcohol testing industry,”  the inpatient assessment and treatment centers and the “authorities” pushing public policy and swaying public opinion to accept irrational and illegitimate authoritative opinion as truth.

And unlike the pharmaceutical industries carefully constructed “bent science” which requires a keen eye and critical analysis , the evidence-base supporting the testing, assessment and treatment industry rests on a foundation that can be aptly characterized as illusions and lies.  The “science” is not just “junk-science” but junk-science of the lowest order–examples of confirmatory distortion and data-dredging to make the data fit the hypothesis abound.   The conflicts-of-interest are not potential but incestual with many of the key players putting their hands in every slice of the pie!

The bad science, bad medicine, bad policy and  bad actors are easy to identify. It would be like shooting fish in a barrel.

So what are the barriers?

Why has this not been done?

The answer to that is complex but  involves a confluence of factors including psychological, political and cultural.  “Feel good fallacy,”  “political correctness, and moral and policy entrepreneurship have effectively swayed the targets intended.  The well-funded misinformation and propaganda was cast with a large net using the same techniques others have successfully used throughout history to accomplish the same.  Moral panics, moral crusades, and a plethora of logical fallacy have been used and used with considerable resources and skill.

So what can we do about it?

The first “step into the breach” is to identify the problem with the first one being the Emperor has no clothes.  Once this is acknowledged it would not take long to address directly the specific problems and erroneous assumptions of this paradigm through the lenses of science, critical reasoning, ethics and common sense.  If this were to be done the entire Potemkin village would fall like a house of cards.

But the very first and simplest step is to use your voice to question this authority. Make it be known.

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History teaches us that silence and secrecy are often the most effective tools of power.   It hides things including very bad things.  It is time to shine a light on this dank dark corner of the medical profession.


It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine” – Marcia Angell 

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“At times to be silent is to lie. You will win because you have enough brute force. But you will not convince. For to convince you need to persuade. And in order to persuade you would need what you lack: Reason and Right”
― Miguel de Unamuno

“I have always found it odd that people who think passive aggressively ignoring a person is making a point to them. The only point it makes to anyone is your inability to articulate your point of view because deep down you know you can’t win. It’s better to assert yourself and tell the person you are moving on without them and why, rather than leave a lasting impression of cowardness on your part in a person’s mind by avoiding them.”
― Shannon L. Alder

Staying silent is like a slow growing cancer to the soul and a trait of a true coward. There is nothing intelligent about not standing up for yourself. You may not win every battle. However, everyone will at least know what you stood for—YOU.”
― Shannon L. Alder


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The Irrational Authority

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The Irrational Authority.  Originally posted on:

Chaos Theory and Pharmacology

A blog dedicated to the study of complex relationships in pharmacology. “Journalism is printing what someone else does not want printed: everything else is public relations.” ― George Orwell

The Irrational Authority

Goodle F. Re: ‘Drug Policy: We Need Brave Politicians and Open Minds
The BMJ. December 17, 2014.

Drug policy: we probably need an “irrational authority”

“One thing is for certain. When society gives power of diagnosis and treatment to individuals
within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model. The birth of Addiction Medicine as an ABMS accepted discipline is sure to be a success for the drug and alcohol testing and 12-step treatment industry, but its spawn is sure to be an inauspicious mark on the Profession and Guild of Medicine and a bane of society for years to come.” ―Michael Lawrence Langan.(1)

References

1. DISRUPTED PHYSICIAN 101.2: “ADDICTION MEDICINE” IS A SELF-DESIGNATED PRACTICE SPECIALTY UNRECOGNIZED BY THE AMERICAN BOARD OF MEDICAL SPECIALTIES–(AN AMA CENSUS TERM INDICATING NEITHER TRAINING NOR COMPETENCE).
URL: https://disruptedphysician.com/2014/11/21/disrupted-physician-101-3-addic… (date accessed: December 17, 2014).

Competing interests: No competing interests

Additional comments

I. The original title of this response:

– Drug policy: we probably need an “irrational authority”.

Please read as:

– Drug policy: we definitely need an “irrational authority”.

II. Societies like the American Society of Addiction Medicine and American Psychiatric Association have been self-proclaimed as “rational authorities”: a euphemism created probably by complex defense mechanisms of self-preservation in a society used to suppress dissenters and reward the wrongdoers.

“The Ministry of Peace concerns itself with war, the Ministry of Truth with lies, the Ministry of Love with torture and the Ministry of Plenty with starvation. These contradictions are not accidental, nor do they result from ordinary hypocrisy: they are deliberate exercises in doublethink.”
― George Orwell, 1984

“Doublethink means the power of holding two contradictory beliefs in one’s mind simultaneously, and accepting both of them.”
― George Orwell, 1984

III. We probably need more “irrational authorities”.

Carl Sagan’s Baloney Detection Kit and the Birth of “Addiction Medicine” as a New Discipline: The Need for an in Utero Diagnostic Assessment Prior to Delivery

3b67f56268909f1dfa2a168a352ad09a“One of the saddest lessons of history is this: If we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. The bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken. Once you give a charlatan power over you, you almost never get it back.”

― Carl Sagan, The Demon-Haunted World: Science as a Candle in the Dark


Carl Sagan devised a toolkit for nonsense-busting and critical thinking, which includes these nine rules:

  1. Wherever possible there must be independent confirmation of the “facts.”
  2. Encourage substantive debate on the evidence by knowledgeable proponents of all points of view.
  3. Arguments from authority carry little weight — “authorities” have made mistakes in the past. They will do so again in the future. Perhaps a better way to say it is that in science there are no authorities; at most, there are experts.2Q==
  4. Spin more than one hypothesis. If there’s something to be explained, think of all the different ways in which it could be explained. Then think of tests by which you might systematically disprove each of the alternatives. What survives, the hypothesis that resists disproof in this Darwinian selection among “multiple working hypotheses,” has a much better chance of being the right answer than if you had simply run with the first idea that caught your fancy.
  5. Try not to get overly attached to a hypothesis just because it’s yours. It’s only a way station in the pursuit of knowledge. Ask yourself why you like the idea. Compare it fairly with the alternatives. See if you can find reasons for rejecting it. If you don’t, others will.

  6. Quantify. If whatever it is you’re explaining has some measure, some numerical quantity attached to it, you’ll be much better able to discriminate among competing hypotheses. What is vague and qualitative is open to many explanations. Of course there are truths to be sought in the many qualitative issues we are obliged to confront, but finding them is more challenging.
  7. If there’s a chain of argument, every link in the chain must work (including the premise) — not just most of them.carli
  8. Occam’s Razor. This convenient rule-of-thumb urges us when faced with two hypotheses that explain the data equally well to choose the simpler.
  9. Always ask whether the hypothesis can be, at least in principle, falsified. Propositions that are untestable, unfalsifiable are not worth much. Consider the grand idea that our Universe and everything in it is just an elementary particle — an electron, say — in a much bigger Cosmos. But if we can never acquire information from outside our Universe, is not the idea incapable of disproof? You must be able to check assertions out. Inveterate skeptics must be given the chance to follow your reasoning, to duplicate your experiments and see if they get the same result.

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A November 2014 Viewpoint article in the Journal of the American Medical Association entitled Addiction Medicine: Birth of a new Discipline describes the need for “integration of addiction specialty physicians throughout the health care system” and how they plan to accomplish this. Citing the 2012 “National Survey on Drug Use and Health” findings that only 11% of Americans in need of treatment recevied it, the authors conclude that the number of addiction psychiatry diplomates (1139) is not meeting the country’s “overwhelming need for addiction specialists. To close this “addiction treatment gap” they propose “greatly expanding addiction physician specialists to include physicians from internal medicine and other specialties.”

Lax Standards

The American Society of Addiction Medicine (ASAM) only requires that you complete a residency — any residency, even dermatology or surgery — plus one year of work in the field and then 50 hours of “education.”  I took the test in 2010 and passed by a large margin without any preparation.

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Remarkably, I received my “diploma” in the mail without every meeting or speaking with anyone.   I simply paid the fee and took the test at one of the local testing centers.   This is concerning as my prior board certifications required accredited residency and training programs and were dependent on not only successfully completing those programs academically but on the reports of my superiors documentation of my character and integrity.  Screen Shot 2014-03-03 at 1.22.02 PM

With these lax standards, the ASAM have been able to create a legion of board certified addictions specialists – outnumbering psychiatrists in the field by 3 to 1.

Takeover of state Physician Health Programs (PHPs)

These ASAM “addiction experts” have become so numerous they have been able to take over almost all the state Physician Health Programs (PHPs). Their national association—the Federation of State Physician Health Programs (FSPHP)–has a stated goal of universal acceptance of the 12-step doctrine: lifelong abstinence, and spiritual recovery as the one and only treatment, as spelled out in the “PHP Blueprint.”

Very much like Straight, Inc in the 70s and 80s, they have cast a wide net with doctors to ensnare them in an endless loop of drug testing and rehab—whether the tests are fabricated or not. The doctors will enjoy no sympathy from the public, and complaining about it is deemed a sign of your “disease.”   Furthermore, ASAM recommends that physicians only be referred to “PHP approved” facilities.  

The medical directors of these facilities can all be found on this list of ”Like-Minded Docs.”  Surprisingly, many Like-Minded Docs were former addicts and alcoholics, some even with criminal backgrounds.  There are felons and even double-felons on the list.

It’s a rehab shell game. Heads I win tails you lose.

And the program is expanding. The organization that oversees the licensing for all medical doctors, the Federation of State Medical Boards, adopted a new policy and approved the concept of “potentially impairing illness” and the Orwellian notion of  “relapse without use.”

Signals for “impairment can be as benign as not having “complete accurate, and up-to-date patient medical records” according to Physician Health Services, the Massachusetts PHP.  Despite the overwhelming amount of paperwork physicians now have, incomplete or illegible records could be construed as a red flag, since as Associate Direct of PHS Judith Eaton notes “when something so necessary is not getting done, it is prudent to explore what else might be going on.” The question is, who is next?”

Not Just For Doctors, But for Everyone

Most of us are unaware of this quiet operation to police and punish our private choices. This is the New Inquisition: a move to expand this program to virtually all professions, all Americans. They want to replace the system currently being used in pilots, bus drivers, and Federal Employees with “comprehensive drug and alcohol testing” that consists of the Laboratory Developed Tests (LDTs) they introduced. Their goal is 24/7 sobriety with complete abstinence, and zero tolerance using tests of unverified validity and unknown reliability.

And they have an implementation plan.  The American Society of Addiction Medicine (ASAM), bolstered by billions of dollars from forced rehab and mandatory drug testing, has a long reach and powerful political friends. ASAM plans to force your physicians to collect your urine in the name of preventive care.

That’s right, that free preventive care you’re getting under Obamacare might soon come packaged with drug screening, as outlined in the ASAM White Paper on Drug Testing.  . Drug testing, they say, is  “vastly underutilized” throughout healthcare. The White Paper—which is well worth reading—describes the use of drug testing “within the practice of medicine and, beyond that, broadly within American Society.”

No matter your profession, if you come for a check up, you may be unwittingly looped into being referred for  “assessment” and “treatment” in a “PHP-approved” facility, where to get free, among other things, you will have to admit you are powerless and surrender to God.

If we don’t start pushing back now, soon there will be mandatory drug testing for every citizen..  A good case can be made for forced drug testing for virtually every profession –a few well-placed opeds in The New York Times and pretty soon we’ll begin to think it’s reasonable to test teachers, food handlers, you name it. They are even recruiting pediatricians to test children.      And in the new system they will not have to change your test from “forensic” to “clinical.”   A doctor-patient relationship renders the test “clinical” and by having doctors collect these specimens and calling the consequences “treatment” they can successfully use these unverified and unregulated tests introduced and marketed through a loophole into mainstream medical practice through a loophole.

One of the major goals of ASAM is recognition by the American Board of Medical Specialties. Should this occur it will inevitably lead to the end of Addiction Psychiatry and, by outnumbering them 3:1 it will be enveloped into the all encompassing field of “addiction medicine.” “Who needs two specialties?” they will argue, especially since most medical experts have accepted that addiction is a chronic relapsing “brain” disease.

And this legion of “authority” will infest our hospitals and mainstream medicine where they will join hospital formulary, ethics, research and other committees where they will be able to outnumber and outvote those of open mind and critical thought just as they did in the PHP system and the field of medicine will then be subverted to the guiding philosophy of the “impaired physicians movement.”

Addiction is a serious problem and those afflicted with it need proper assessment, diagnosis and treatment.  This illegitimate and irrational authority does not provide that.  Having had a disease does not confer authority status–I have asthma but that does not make me an expert in reactive airway disease.    Neither does interest in something, no matter how sincere, make one an expert.  I’ve had a sincere interest in science since I was a child but did not claim to be an expert in science when I was 7 because I was a member of Sir Isaac Newton’s Scientific Club.   Aside from the $2200 I had to pay and sitting through the exam gaining  ABAM certification was not all that different. This is not “expertise.”

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Prior to accepting “addiction medicine” as an ABMS approved specialty their research, tenets and basic principles of should be subjected to critical reasoning and academic analysis of the Cochrane caliber to see if they are actually valid.  This includes their claims of remarkable success in treatment and the non-FdA approved laboratory developed tests (LDTs) that they introduce.d.    The authorities and experts involved in promoting the ideology, testing and treatment should  be subject to and Institute of Medicine (IOM) conflict of interest analysis.   Who is profiting? And all of the statements, claims and suppositions regarding addiction and the guiding philosophy of the group should be subjected to Carl Sagan’s Baloney Detection kit.   If this were done the results would be failure on all three counts. False premises lead to false constructs.

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One thing is for certain. When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model.

The birth of Addiction Medicine as an ABMS accepted discipline is sure to be a success for the LDT drug and alcohol testing and 12-step assessment and treatment industry, but its spawn is sure to be an inauspicious mark on the Profession and Guild of Medicine and a bane of society for years to come.images

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.

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.

“You have an Irish last name-good luck finding anyone who will believe you!” [ are not an alcoholic] -Linda Bresnahan, Director of Operations, PHS [after fabricating positive alcohol test]

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Integrity and Accountability—Going on two months and no winners stepping forward. Defend the MRO Procedurally, Ethically or Legally and you win all the prizes.

As the Medical Review Officer (MRO)  for the Massachusetts state Physician Health Program (PHP), Physician Health Services, Inc. (PHS, inc.), Dr. Wayne Gavryck’s responsibility is simple.  He is supposed to verify that the chain-of-custody  in any and all drug and alcohol testing is intact before reporting a test as positive.

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Dr. Gavryck evidently did not do that here.  In fact for more than a year he helped cover up an alcohol test that was intentionally fabricated at the behest of PHS Medical Director Dr. Luis Sanchez, M.D. and Director of Operations Linda Bresnahan (who told me when I confronted her with the fact that I have never had or ever even been suspected of having an alcohol problem “you have an Irish last name–good luck finding anyone who will believe you!”)

It took a formal complaint with the College of American Pathologists to get the truth out.  The whole fiasco can be seen here and here.

What Gavryck and his co-conspirators did is egregious and ethically reprehensible.  It shows a complete lack of moral compass and personal integrity.  What was done from collection to report to coverup  and everything in-between is indefensible on all levels (procedurally, ethically, and legally).

The documentary evidence shows with clarity that this was not accident or oversight.  It was intentional and purposeful misconduct.  I think everyone would agree that there should be zero-tolerance for forensic fraud in positions of power.    Any person of honor and civility would agree.

Transparency, regulation, and accountability are necessary for these groups.   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.  I’ll erase my blog and vanish into the woodwork.  But 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 Sanchez and 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.

It is people just like this who are killing physicians across the country.   The body count is vast and multiple.  And those who are caught doing dirty deeds such as this need to be held accountable.

Please help me get this exposed, corrected, and rectified.  The doctors of Massachusetts and the doctors of this entire country deserve better than this.

via 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!.

Details of how the state PHP scam operates can be seen below as pertains to my case.   Occurring in most states under the FSPHP  ( although some are worse than others) the Method of Operation (M.O)  is the same.

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I.  July 28th, 2011.   Reporting a Positive Test

This letter from Physician Health Services, Inc. Medical Director (and past President of FSPHP) Dr. Luis Sanchez, M.D. to  the Massachusetts Medical Board reports a markedly high level for Phosphatidylethanol (PEth), an alcohol biomarker test being used by Physician Health Programs to detect alcohol use.

The cutoff for heavy drinking is anything greater than 20 ng/mL.  Mine came back at a level of 365.4 ng/ml!  This level  is  suggestive of end-stage alcoholism and putting away a half-gallon a day of the hard stuff.   It is, in fact, reportedly the second highest level in history and the other guy was dead on arrival.

After reporting the blood test as dirty, Sanchez then requests a “reevaluation.”

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II.  Requested Evaluation Limited to “Like-Minded Docs”

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I was given three choices for this re-evaluation as listed above.   The Medical Directors can all be found on this list of “Like-Minded Docs”  Their philosophy of 12-step “intervention” can be seen here.

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Dr. David Withers, M.D.  Associate Medical Director of Marworth Treatment Center.

Dr. Marv Seppala, Chief Medical Director of Hazelden.

Dr. Omar Manejwala, M.D.   Medical Director of Hazelden.

Dr. Mike Wilkerson, M.D.,  Medical Director of Bradford Health Services-Warrior

This referral to “like-minds” is part of the state Physician Health Program scam. It is essentially self-referral as the choices are limited to “PHP-approved” assessment and treatment centers.    For doctors (and now pilots) an objective and independent referral is out of the question.    It is, in fact, a rigged system.

Note Dr. Wayne Gavryck, M.D.    Medical Review Officer (MRO) for the Massachusetts PHP, PHS, Inc. is also on the list of “Like-Minded Docs.”

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Dr. Greg Skipper, the physician who proposed and promoted the use of EtG, EtS, PEth and other non FDA approved “Laboratory Developed Tests (LDTs) for forensic testing is also on the list.

Former White House Drug Czar Dr. Robert Dupont who is claiming Physician Health Programs (PHPs) are the “new paradigm” for substance abuse treatment is also on the list.    Dupont wants to use the PHP model (including the non-FDA approved drug and alcohol tests they introduced) for other Employee Assistance Programs (EAPs) and populations (including kids and students.).

III. November 29, 2011.  PHS Agrees to my Request for “Litigation Packet”

Any and all forensic drug and alcohol testing requires strict chain-of-custody.   Documentation of chain-of-custody is necessary to protects both those ordering and doing the testing and the person being tested.       Forensic laboratories provide documentation of chain-of-custody in a document called a “litigation packet.”

On November 29, 2011 PHS agreed to my request.


IV. Discovering Procedural Misconduct and Forensic Fraud

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The screenshot above is an ID card used for random drug and alcohol testing.  It is a card issued by Physician Health Services, Inc. and contains my picture, my initials and an ID # 1310.     The number #1310 is a unique identifier like a social security number or medical record number.  It is used to document “chain-of-custody” for testing and identifies who I am for laboratory testing.

The document below is a fax from Physician Health Services, Inc.

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The document is signed by Mary Howard ,  whose job description is as below:

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“If you have any questions” the document sates, “please call Linda Bresnahan 781-434-7404.”   Ms. Howard assists Ms. Bresnahan in the drug and alcohol testing of doctors monitored by PHS.

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Free Educational Webinar: How to Position Yourself as an EXPERT!

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The validity and reliability of opinions lie in their underlying methodology and evidence base. Reliance on the personal authority of any expert or group of experts is the fallacy of appeal to authority.

I have asthma but that does not make me a Pulmonologist.  That addiction “specialist” diagnosing and treating you may have 5 years prior been a proctologist; and maybe not even a very good one at that.

Somewhere there may be doctor with no post-graduate training in surgery wielding a scalpel and calling himself an expert surgeon, but it is difficult to imagine that he is a very good one.

https://disruptedphysician.com/2014/11/18/disrupted-physician-101-2-for-what-its-worth-appeal-to-authority-and-the-logical-fallacy-of-special-or-secret-knowledge/

 

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Addiction Medicine: The Birth of a New Discipline

Somehow, I don't think this is quite what they had in mind!

Leigh (Bella) St John


“How to Position Yourself as an EXPERT, Make More Money and Help More People, by Becoming a Published Author – Even if You Don’t Know Where to Start!” Think about it – if you need to see a chiropractor, for example, would you rather see a general chiropractor, or one who has positioned …
http://leighstjohn.com/free-educational-webinar-how-to-position-yourself-as-an-expert/

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Disrupted Physician 101.2: “Addiction Medicine” is a Self-Designated Practice Specialty Unrecognized by the American Board of Medical Specialties–(An AMA Census Term Indicating Neither Training nor Competence)

“Spirituality can go hand-in-hand with ruthless single-mindedness when the individual is convinced his cause is just”

Michela Wrong, In the Footsteps of Mr. Kurtz: Living on the Brink of Disaster in Mobutu’s Congo

Addiction Medicine: The Birth of a New Discipline

Addiction Medicine is currently not recognized by the American Board of Medical Specialties (ABMS).  It is still a a Self-Designated Practice Specialty and the American Board of Addiction Medicine is a Self-Designated Board.  So too is the American Academy of Ringside Medicine and Surgery, the American Academy of Bloodless Medicine and Surgery and the Council of Non-Board Certified Physicians.  But these Self-Designated Boards do not have the multi-billion dollar drug and alcohol testing and treatment industry supporting them. Addiction Medicine has deep pockets, and if the November 2014 issue of the Journal of the American Medical Association (JAMA) is a harbinger of what’s to come, this self-designated practice specialty currently being certified by a self-designated Board and bereft of anything resembling the educational and professional standards for quality practice in a particular medical specialty or subspecialty as defined by the ABMS, the American Council on Graduate Medical Education (ACGME) and the Institute of Medicine (IOM) may soon robber baron its way into acceptance by the Medical Profession.

One thing is for certain.  When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model.  The birth of Addiction Medicine as an ABMS accepted discipline is sure to be a success for the drug and alcohol testing and 12-step treatment industry, but its spawn is sure to be an inauspicious mark on the Profession and Guild of Medicine and a bane of society for years to come.

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via Disrupted Physician 101.2: “Addiction Medicine” is a Self-Designated Practice Specialty Unrecognized by the American Board of Medical Specialties–(An AMA Census Term Indicating Neither Training nor Competence).

 

Disrupted Physician 101.3 –“For What it’s Worth”— The ASAM/ABAM Diploma Mill

“In a time of universal deceit, telling the truth is a revolutionary act.”
— George Orwell

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I can think of no other specialty or subspecialty in the profession of medicine where non-existent expertise can be incontestably announced and implemented.  If I claimed to be an ace neurosurgeon or an expert otolaryngologist and started practicing my claimed skills in the hospital I would be called on it pretty quick by both colleagues and patients–deemed a delusional fraud and run out on a rail within a week.  Both law enforcement, attorneys and psychiatry would be called in short order.

Yet doctors who have not met the usual and customary standards for professional and educational quality that have been identified for medical specialties and subspecialties are able to claim expertise in “addiction medicine” and everybody just lets them.

To make this point I sat for the 2010 American Board of Addiction Medicine Certification Examination.  I did this to make a point–kind of like seeing how easy it is to buy a gun at a Walmart.

I simply went to the ABAM Website, completed the application and paid the fee.

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The requirements to sit for the exam included so many “practice experience hours” over the past five years and 50 CME credits related to addiction.

With a year of psychopharmacology research, a half-day per week moonlighting at the MBTA medical clinic giving drug tests to bus drivers and another overnight moonlighting job giving medical clearance to patients at a local psychiatric hospital detox unit I satisfied the first requirement.   For the latter I looked through the last five years of morning reports, noontime lectures and grand rounds I went to and added them up and, falling a little short supplemented the CME credits with some online modules.

And with that I was given a date at Pearson to take the test.

I have absolutely no training or education in the field of addiction medicine.  I didn’t pick up a book or study anything. I did not prepare at all. I did not even get a good night’s sleep the night before and stayed up until 2:30 a.m.   Nevertheless I went to the testing facility the next morning and finished the test within an hour and a half.  My score is below.  Aced it.   Passing score was 394 and I got a 459.

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And the point I am trying to make is I am no expert in Addiction Medicine.  Neither is 4000 of me. Yet the letter below says I am.  Majority apparently rules.

Giving false expertise to the unqualified and granting them power over others is just as dangerous as the gun from Walmart.  They can both kill.

An interest in something does not an expert make. If we allow this then the ASAM 12-step chronic brain disease model not only swallows addiction medicine but tarnishes all of medicine.  An imposition by force and the deep pockets of the billion dollar drug and alcohol testing, assessment and treatment industry.

ASAM is not a true medical specialty. It is a special interest group.   ABAM is not recognized by the American Board of Medical Specialties (ABMS).

The arguments seem to be:

1) Addiction is a prevalent “disease”  that needs to be “treated;”

2) There are not enough Addiction Psychiatrists to diagnose and treat them.

3) Being an M.D. addict or alcoholic gives enough knowledge and apprenticeship skills to diagnose and treat others with the same affliction.

4) Let’s utilize them to fill the void.

This is logical fallacy and it is dangerous.

The validity and reliability of opinions lie in their underlying methodology and evidence base. Reliance on the personal authority of any expert or group of experts is the fallacy of appeal to authority.

An interest in something does not an expert make.  I had an interest in science as a child but my certification as a member of Sir Isaac Newton’s Scientific Club did not make me a scientist.

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I have asthma but that does not make me a Pulmonologist.  That addiction “specialist” diagnosing and treating you may have 5 years prior been a proctologist; and maybe not even a very good one at that.

Somewhere there may be doctor with no post-graduate training in surgery wielding a scalpel and calling himself an expert surgeon, but it is difficult to imagine that he is a very good one.

I received my ABMS certification without meeting a single person. It was all done by mail.   This fits the very definition of “Diploma Mill.”  This is not to besmirch those with a sincere interest in helping others with addiction.  Many if not most of those involved are sincere. But this is not expertise.  This is not authority. And, as we have seen, this low bar opens the door for some very bad apples.

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“This election is not about issues,” Rick Davis, John McCain’s campaign manager said this week. “This election is about a composite view of what people take away from these candidates.” That’s a scary thought. For the takeaway is so often base, a reflection more of people’s fears and insecurities than of our hopes and dreams.
— Judith Warner, New York Times, September 4, 2008

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