Robin Williams Melancholy Suicide–Hopelessness, Helplessness and Defeat

 
Published one year ago on DisruptedPhysician.com/blog.  Although more details have been revealed the premise of the post remains the same. Depression, as with any mental illness, needs to be diagnosed, monitored and treated by educated, trained and experienced experts in depression. Not self-proclaimed experts.  
 
There’s something in his soul
O’er which his melancholy sits on brood,
And I do doubt the hatch and the disclose
Will be some danger—which for to prevent,
I have in quick determination……..
It shall be so.    Madness in great ones must not unwatched go.
—Hamlet Act III, Scene 1
According to Radar Online Robin Williams is looking “grim and focused.”  Grim? Yes. Focused? No.  His visage is one of entrapment, despair, and dread.
In  F. Scott Fitzgerald’s  The Great Gatsby, Nick Carraway observes that “the loneliest moment in someone’s life is when they are watching their whole world fall apart, and all they can do is stare blankly”   This is not focus but melancholia–hopelessness, helplessness, and defeat.
In 1896 Émile Durkheim described “melancholy suicide” as being “connected with a general state of extreme depression and exaggerated sadness, causing the patient no longer to realize sanely the bonds which connect him with people and things about him. Pleasures no longer attract.”  Williams’ face  is weighted with melancholy. Not focus.

Heightened perceptions of defeat and entrapment are known to be powerful predictors of suicide. According to the “Cry of Pain” model people are particularly prone to suicide when life  experiences are interpreted as signaling defeat, defined as a sense of a “failed struggle.” Unable to find some sort of resolution to a defeating situation, a sense of entrapment proliferates and the perception of no way out provides the central impetus for ending one’s life.

As in all suicidal tragedies, the role of addiction and mental illness has been posited as the cause. Although depression and substance abuse are the two biggest risk factors for suicide, neither explains  completion of the act–the descent from ideation and planning to finality and oblivion.  Saying suicide is caused by depression and drugs is like claiming marijuana is a “gateway drug” to heroin.  It may be a a common related  pre-conditional occurrence but it is not the cause.  It is a non sequitur.   And just as most marijuana users never develop an inclination to stick an opiate filled needle into their veins, the majority of depressed individuals and substance abusers do not kill themselves.   One does not lead to the other.

And as we have seen in the reports of bullied teenagers who have died by suicide, it is all too often the bullies themselves who are quickest to pronounce this conclusion.   Attributing suicide to mental illness and substance abuse deflects culpability.  It negates the need for further inquiry.  It creates an absence of the need to change.   The rationalization diffuses both individual and collective blame.   It scatters  responsibility and guilt.  It is both an individual and community defense mechanism.  Incessantly and chronically shaming, humiliating, and degrading another person because of race, body type, sexual preference or whatever perceived eccentricity or non-conformity threatened the community herd was irrelevant.  It played no role.  It was drink, drugs, or depression–the unspoken understanding is  they would have done it anyway.   And no one stops to ponder that said depression or desire to alter ones mental state just might in actual fact be a symptom of the humiliation and shame they themselves created.   And it works.  The bullies are never held accountable. But it is nevertheless they who figuratively loaded the gun, placed it in the victims mouth, and pulled the trigger.

The  link between bullying and suicide is well known,  especially when combined with entrapment and the feeling there is no way out.  “They would have done it anyway.” No, they would not have and a modicum of perceived support, concern, kindness and understanding  from others may have prevented it.

Dr. Drew Pinsky seemed omnipresent in discussing Williams suicide; delivering authoritative pronouncements with seeming omniscience and certainty.     “The death of Robin Williams has led me to this plea — let’s loudly and seriously address something that’s still hidden, stigmatized and even ignored in this country: Mental illness,” Pinsky writes on his blog.  I don’t see the logic here.  How is exposing mental illness a product of Williams suicide.  He was  open, unashamed, and forthright about his prior addictions and depression.  He was not hiding it.  Neither is the 21st century for that matter.

The more important issue that I see needs pleading, is that mental illness be properly, accurately, and thoughtfully diagnosed and treated.

Depression, as with any mental illness, needs to be diagnosed, monitored, and treated by educated, trained, and experienced experts in depression.   Not self-proclaimed experts.     Pinsky’s specialty is “addiction medicine” and he is “board certified” by the American Board of Addiction Medicine (ABAM).

The American Society of Addiction Medicine can trace its roots to the 1954 founding of the New York City Medical Society on Alcoholism (NYCMSA) by Ruth Fox, M.D.,  whose husband died from alcoholism. This  group promoted the concept of alcoholism as a chronic relapsing brain disease requiring lifelong spiritual recovery through the 12-steps of AA. And the primary goal of the ASAM is and always has been the acceptance of 12-step doctrine, lifelong abstinence, and spiritual recovery as the one and only treatment for addiction.  It always will be.

This philosophy and guiding doctrine stems from the “impaired physician movement”, a group that,  according to British sociologist G.V. Stimson: ” 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.”  This group grew in numbers, organized, and eventually became the ASAM.

The American Board of Medical Specialties (ABMS)  recognizes 24 medical specialties and subspecialties. Addiction Medicine is not one of them. The only ABMS recognized subspecialty is Addiction Psychiatry and it requires a four-year psychiatric-residency program followed by a 1-year Fellowship focusing on addiction in an accredited training program.

In contrast, ABAM certification requires only a medical degree, a valid license to practice medicine, and completion of residency training in ANY specialty.

Hazelden, the facility where Williams was admitted in July is an ASAM facility.  And the  Medical Director, Marvin Seppala is a Like-Minded Doc.   Unlike most ASAM physicians, however, Seppala is a psychiatrist. But he is a psychiatrist brought up in the folds of ASAM ideology. He was, in fact, the first adolescent graduate of Hazelden in the 1970s when he completed the program at the age of 19.

Pinsky, predictably goes on to state that “Williams had a brain disease, ” He posits it against demons or devils as if it is either/or.  This concrete splitting of complex subjects into two separate entities to claim only one correct is just one of many simplistic and misleading “false dichotomies” used by the ASAM.     Of course addiction is a brain disease.    But in reality the definition is unhelpful unless we are living in the Victorian era. It’s like saying Gonorrhea is a genital disease  not  venereal (from Latin venereus “of sexual love”).  In reality it involves a number of factors including both psychosocial and medical.  Cornering a definition does nothing to advance knowledge and care.

Addiction is multifactorial and diverse. Simplifying it into binary options does little to advance understanding.   And it too involves a variety of issues including the situational, the psychosocial, the genetic and the biochemical.   Like every other medical issue there are a number of factors to be taken into consideration.  And imposing the 12-steps to salvation on all-comers is not only illogical, but anti-science, and downright improper.    It can also be deadly.  Especially when the the person it is imposed on is not a full-blown addict but a substance abuser. an experimenter, a dabbler, or someone who has simply had a “lapse.”

The ASAM emphasizes that addiction is a “brain disease” and not a “moral failing” in a mutually exclusive construct that allows either one or the other but not both.  It is presented as a dichotomy in which the promotion of one both precludes and dismisses the other.  It is either black or white. Period.

But substance use, abuse, and addiction comes in every color, saturation, hue and shade.   Psychosocial, behavioral, and social factors play a role in the actions and deeds of everyone including those addicted to alcohol and drugs.  The disease concept neglects this multifactorial confluence of factors that ultimately produce a given behavior by viewing all behavior a product of the “disease.”   Any and all behavior is simply a product of a “brain disease” in the addicted individual who cannot be trusted to make decisions on his own but has to be told what to do as part of the treatment.   A danger to himself and others  the addict cannot be trusted to make his own decisions, so we must make them for him.

The chronic brain disease model is an oversimplification of the complex and a false dichotomy–so too is bifurcating  “recovery” and “relapse,” treatment” and  “discipline,”  and “confession”and “denial.”  Anything less than total abstinence constitutes an illness.

One true dichotomy  that exists among the proponents of the chronic brain disease model of addiction with  lifelong abstinence and spiritual recovery is  a  person is either “with them” or “against them.”

Dr. Drew Pinsky notes “there were a number of factors” that contributed to William’s condition.  He states “alcoholism is certainly one. He may have had a genetic potential for depression. Addiction and depression can be an easily fatal combination.”    Non-sequitur.

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Depression needs to be treated by thoughtful, educated, competent and trained experts in depression not self-declared experts.    ASAM doctors are not “real” experts.  They are pretend experts trumpeting one frozen paradigm while dismissing or ignoring others.  It is expert opinion where the goal is not new knowledge and and new discovery. The die  is cast.  And most of the “research” put out by this group consists of methodologically unsound studies published in their journals in which an attempt is made to make the data fit an already determined hypothesis.

Point being that depression needs to be evaluated and treated by trained professionals who understand depression. Psychiatrists, psychopharmacologists, neuropsychologists, and psychologists schooled in a broad spectrum of treatment modalities.   Numerous depression treatments are available.  If one treatment fails or is ineffective then others must be tried.    Most depression is treatable, especially subacute or acute depression.  SSRIs, SNRIs SNDRIs, tricyclics, MAOs, and atypical antidepressants are available. Different types of psychotherapy are available–cognitive behavioral therapy, interpersonal therapy, dialectic behavioral therapy, mindfulness therapy, and Jungian psychoanalysis can be beneficial for people suffering from depression.  And ECT and TMS can also play a role in depression refractory to medications and psychotherapy.

Depression is extremely common in Parkinson’s disease but due to the dopamine loss it requires special consideration of what drugs to use and not use.  SSRI’s can sometimes worsen the condition.   Consultation with a knowledgable and experienced neurologist is critical.

I do not know what assessments or treatments were being tried in Robin Williams.   But the treatment modalities offered by ASAM physicians are usually few to one.

The majority of “addiction medicine” specialists are not psychiatrists.   For all you know you may find yourself being treated by an addiction  “specialist” who was a practicing proctologist just a few years prior; and perhaps not even a good one at that.

Moreover, many of the ASAM physicians are “anti-medication” and may take people off medications that have been helping them and that they need.   And the devastating results are often  seen after the patient has been discharged home.

Taken off drugs while in rehab and sent home without them, the beneficial effects may wear off gradually. And as they do mental conditions may deteriorate.   Manic episodes, paranoid psychoses, extreme anxiety, and profound depression can all occur well after someone has been discharged home.   So can suicide.

And when this happens the ASAM doctors  blame it on their fatal “disease” when, just as is seen with the suicides of bullied teens, it was actually they  who put the gun to their heads and pulled the trigger.

Depression needs to be treated by experts in depression.   Putting someone in a one-size fits all shackled and frozen mold can be fatal.  And calling them  helpless addicts with a chronic disease who have no control due to character defects adds kindling to the fire.  Depressed people need empowerment not powerlessness;  self-esteem not shame.  Shame is devastating. It goes right to the core of the person’s identity making them feel exposed, inferior, and degraded.  Dehumanized, delegitimized, and vulnerable.  The link between bullying and suicide is clear.  And this is especially true when combined with entrapment.  The feeling there is no way out.

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.   And it can be fatal.

Under a dictatorship everything else becomes subordinated to the guiding philosophy of the dictatorship.   Corresponding doctrine replaces ethics as well as professional guidelines, standards of care, and evidence based medicine.  Ideology usurps critical thinking.  Having only a hammer, everyone is seen as a nail  A symphony with just one note.

And faith in institutions demands mass adherence to faith in that authority. Direct challenge to the status quo undermines the publics blind faith. The biggest obstacle is thimages-4at this system allows them to throw the normal rules of conduct under the imperative of a higher goal assumed to trump all other consideration.

All of medicine needs to be predicated on competence, thoughtfulness, good-faith, civility, honesty, and integrity. This is universally applicable.  All specialties of medicine are required by that specialty to practice evidence based medicine and avoid conflicts of interest except one–addiction medicine.  Due to a confluence of factors they have been given a pass.

But the validity and reliability of opinions lie in their underlying methodology.  Reliance on the personal authority of any expert or group of experts is a logical fallacy.

And in order to save American Medicine this  problem needs to be clearly recognized.  The ASAM has a monopoly on addiction medicine. Treatment of substance abuse in this country is, in fact, defined by the impaired physicians movement paradigm.

A paradigm that is in actuality rife with methodologically flawed studies, cherry picking, bias, and cognitive distortion.  A paradigm that places expert opinion, ideology, and doctrine above critical thinking and evidence base.   Coercion and control are placed above patient autonomy and individual choice because the patient has a “disease” and can’t think for himself.  So we’ll think for him.    The  conflicts of interest are many and complex. They would be unimaginable in other fields of medicine.

But  I agree with Pinsky on one point.  His  comment that addiction and depression can be a deadly combination is true. And this is especially so when treatment of the addiction is the primary focus and consists of imposed 12-step indoctrination and the depression remains untreated or ineffectively treated.    That is a deadly combination indeed–and one that can easily lead a person down the road of hopelessness, helplessness, and despair. And it is time the medical field as a whole shined some light on this.  Let’s hold addiction medicine to the same standards of conduct and care as the rest of the profession.

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The Medical Profession, Moral Entrepreneurship, Moral Panics, and Social Control

The Medical Profession, Moral Entrepreneurship, Moral Panics, and Social Control.

 “Few, no matter how desperate, seek help of their own accord.”  says Dr. Marv Seppala, M.D., Chief Medical Officer at Hazelden, one of the “PHP-approved” drug and alcohol assessment and treatment centers located in Center City, Minnesota.  “Physicians are intelligent and skilled at hiding their addictions.”

“They’re often described as the best workers in the hospital,” he says. “They’ll overwork to compensate for other ways in which they may be falling short, and to protect their supply. They’ll sign up for extra call and show up for rounds they don’t have to do.”

In reality this is ludicrous–knee slapping absurd.   If the results of this authoritative opinion were not so dire these statements would, in fact, be comical.   Such is not the case, however, and opinions like Seppala’s have been taken at face value and, as a result, the aftermath has been and continues to be tragedy.IMG_0706

Addiction, alcoholism and substance abuse to any significant degree produce both physiological and behavioral manifestations in the user. It is cause and effect.  Pathophysiology conforms to law of nature and not the whims of the impaired physician movement.

What anomalous  aspect of intelligence or special skill set would enable a doctor to hide an addiction?

The ASAM definition of addiction is characterized by cognitive, behavioral and emotional changes which include “impaired control” so how would intelligence rein it in?  Furthermore, what unique logical, rational, analytical, factual, abstract, intuitive or objective aspect of intelligence is responsible for this preternatural fortitude?

How is the intelligence of a doctor any different from the intelligence of any other human being?  And what prodigious abilities do doctors have that enable them them to cloak the  behavioral manifestations and stave off the physical consequences chemical addiction to such a degree that they are able to maintain the facade of being  “described as the best workers in the hospital?”  Is it an innate inborn endowment or an esoteric knack acquired during medical training?

IMG_0728What ability and artistry would allow a profession to weave such a web of fortitude that they can convincingly shroud the myriad signs and symptoms of drug and alcohol abuse unlike the regular folk?    Perhaps access to ophthalmic vasoconstrictors and beta blockers to temper the pupillary dilation and tremulousness associated with stimulants or botox and a testosterone patch to mask the skin changes and maintain lean muscle mass in the throes of alcoholism?

How does overworking “protect their supply” and why would they keep it at the hospital?  These people have prescription pads and last I checked there were no cocktails shakers or bottles of Jameson in the doctors lounge.

And for the life of me I cannot comprehend why an alcoholic or addict doctor would sign up for extra call and show up for rounds on his day off.  What would be the point?

In reality a doctor with a drug or alcohol problem would be erratic with call and show up late for rounds.

This is just another example of authoritative opinion with no substantive value. It is moral entrepreneurship at its finest; the fallacy of appeal to authority and secret knowledge.

If Seppala were asked to provide the evidence-base and rationality of these statements he would be hard pressed to do so.  The question would be met with deflection, logical fallacy, references to the opinions of like minds and thought-stopping memes.  “You need a check-up from the neck up,”  your best thinking got you here,”  there is no “I” in “team,” “denial isn’t just a river in Egypt.”  Oh, yeah?   well “Rogue” isn’t just a river in Oregon and, while we are at it, “Boring” isn’t just a town!

It is this type of misinformation and propaganda that allows the “impaired physician movement” to  drag away the “best worker in the hospital” and deem him “in denial.”

“We were so surprised. We didn’t even know he had a problem”  say the nurses, patients and colleagues left behind.

Well the truth is he probably didn’t!

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Blind-faith and unquestioning allegiance to expert authority deflects scrutiny and analysis.  Few red flags are raised as this type of moral preening promotes misguided plausibility and complacency in the belief that these are indeed experts with good intentions. This needs to be addressed.

But if you look at any of the current “moral panics” that are being used to suggest random suspicion-less drug testing of doctors or promoting the Physician Health Programs as successful and replicable models, you will inevitably find a doctor on this list behind it. It is a given.

And the invitation goes out to Seppala to debate this in a public forum on a level playing field.    Not gonna happen because it would be impossible for him to address and answer the questions rationally,  directly and with any tiny scrap of evidence based data.

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Utilizing the Medical Profession as a Urine Collection Agency–The ASAM White Paper on Drug-Testing

“The rights of every man are diminished when the rights of one man are threatened.” ― John F. Kennedy

Before the  2012 Drug and Alcohol Testing Industry Association (DATIA) annual conference, Dr. Robert Dupont delivered a speech entitled “Drug Testing and the Future of American Drug Policy.”    He describes a “New Paradigm” for substance abuse treatment that enforces “zero tolerance for alcohol and drug use”  that is enforced by monitoring with frequent random drug and alcohol tests in which positive tests are “met with swift, certain, but not draconian, consequences.” The paradigm is based on the current Physician Health Programs blueprint.  Dupont states:

“…physician health programs , have set the standard for effective use of drug testing. These pioneering state programs provide services to health care professionals with substance use disorders. The programs are run by physicians, some of whom in recovery themselves. PHPs feature relatively brief but highly focused treatment followed by active lifelong participation in the 12-step fellowships of Alcoholics Anonymous and Narcotics Anonymous. The key to the success of the PHP system of care management is the enforcement of the standard of zero tolerance for any alcohol or other drug use by intensive long-term random testing for both alcohol and drugs with swift and certain consequences for even a single use of alcohol or any other drugs of abuse. PHPs use drug panels of 20 or more drugs. The PHPs commonly use EtG and EtS tests to detect recent alcohol use. Similar comprehensive programs have been developed for commercial pilots and attorneys. These innovative programs of care management produce unprecedented long-term, outcomes.”

Physician Health Programs use a doctor’s medical license as “leverage” in what they call “contingency management.”   What this means is that a doctor who is being monitored by a PHP must comply with any and all demands of the PHP under threat of being reported to the state Medical Board and loss of licensure. Dupont wants to extend the PHP model to other populations including kids.

The 2013 American Society of Addiction Medicine White Paper on Drug Testing describes the organizational structure of the “New Paradigm” which includes utilization of the medical profession as a urine collection agency for their drug and alcohol testing. When a doctor-patient relationship exists the testing is rendered “clinical” rather than “forensic.” Thus the consequences of a positive test can be deemed “treatment” rather than punishment. This bypasses the strict chain-of-custody and Medical Review Officer requirements designed to ensure accuracy and minimize false-positives.  Forensic drug testing is tightly regulated because the results a positive test can be grave and far reaching.  Erroneous results are unacceptable.

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The ASAM paper describes mandated drug-testing for patients in a number of specialties including adolescent medicine, psychiatry, obstetrics, and geriatrics.  Contingency management will involve “the potential for loss of current or desired employment, or threatened loss of or restrictions on a professional or commercial license, or legal and forensic necessity.”
“This White Paper encourages wider and “smarter” use of drug testing within the practice of medicine and, beyond that,broadly within American society. Smarter drug testing means increased use of random testing* rather than the more common scheduled testing,* and it means testing not only urine but also other matrices such as blood, oral fluid (saliva), hair, nails, sweat and breath when those matrices match the intended assessment process. In addition, smarter testing means testing based upon clinical indication for a broad and rotating panel of drugs rather than only testing for the traditional five-drug panel.”

As onerous, unwarranted and unjust as this future dystopia sounds it may very well come to fruition.    Across the country doctors have been going to the media, law enforcement, and the ACLU complaining of ethical breaches, civil rights violations, abuse and criminal activity only to be turned a deaf ear.   The Federation of State Physician Health Programs has been able to construct this scaffold with no meaningful opposition and below the public radar. They have done this by removing accountability at all levels.  By preventing access to information and erecting a system without oversight no consequences exist to deter misconduct and abuse.  The same tactics and strategies will be used as they expand this to other populations.

American Society of Addiction Medicine, The Federation of State Physician Health Programs, and Like-Minded Docs 

“With one arm around the shoulder of religion and the other around the shoulder of medicine, we’d resolve their differences. Having learned to live so happily, we’d show everybody else how. Why, we thought, our Society of Alcoholics Anonymous might prove to be the spearhead of a new spiritual advance! We might transform the world”.–Twelve Steps and Twelve Traditions 1953  A.A. World Services

The American Society of Addiction Medicine exists to trump the 12-step chronic relapsing brain disease model of addiction as defined by A.A.   The authoritarian view necessitates the authority maintain authority so everything is engineered around that goal.

The American philosopher Eric Hoffer noted:

“The only way to predict the future is to have power to shape the future. Those in possession of absolute power can not only prophesy and make their prophecies come true, but they can also lie and make their lies come true.” 

The PHP model is built on the very foundation Hoffer describes.

“Addiction Medicine” not a recognized medical specialty.

This begins with the ASAM itself.  “Addiction Medicine” and ABAM “board certification” is not recognized by the American Board of Medical Specialties.  The requirements for this self-certification are not commensurate with ABMS certifications and only requires a medical license and board certification in ANY specialty.

Dubious Drug Testing-Not FDA approved, Conflicts-of-Interest

Federal workplace drug testing is done in accordance with mandatory guidelines. This testing is regulated using FDA approved tests with established sensitivity, specificity, and cutoff levels.  FDA approval requires rigorous research and proven validity.    The FDA requires valid scientific evidence (with both clinical and analytical validation)     The  FSPHP has introduced non-FDA drug testing via a loophole that removes accountability.  The EtG, EtS, and PEth tests were introduced as  Laboratory Developed Tests (LDTs) with little evidence base.  The LDT pathway was developed for “clinical” tests of low market potential that would not otherwise make it to market as the FDA approval process would be prohibitive.  An LDT  does not even require in vivo testing or proof that the test actually tests for what it s claimed to test.   Without FDA oversight, however, the labs can claim anything they want with no accountability.   After getting the labs to develop the tests the FSPHP then convinced the Medical Boards they were both necessary and accurate and began using them on doctors in PHP programs.

Changing Public Policy and Regulatory Authority to Increase Power and avoid Accountability

The 2011 FSMB Policy on Physician Impairment identifies, defines, and essentially legitimizes “potential impairment” and “relapse without use.”

A PHP Should be empowered to conduct an intervention based on clinical reasons suggestive of potential impairment.  Unlike the Board which must build a case capable of withstanding
legal challenge, a PHP can quickly intervene based on reasonable concern."

“Empowered” to conduct an “Intervention” for reasons “suggestive” of “potential” impairment means a doctor can be pulled out of practice for anything.  It essentially gives them carte blanche authority. The disregard for physician rights, due process and validity is self-evident.

in 2011 The ASAM issued a Public Policy Statement on coordination between PHPs, regulatory agencies, and treatment providers recommending  that  only “PHP approved” treatment centers be used in the assessment and treatment of doctors.  A recent audit of the  North Carolina PHP found financial conflicts of interest and no  documented criteria for selecting the out of state treatment centers they used.  The common denominator the audit missed was that the 19  “PHP-approved” centers were all ASAM facilities whose medical directors can be seen on this list.

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

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.”

G. Douglas Talbott defines  “relapse without use”  as  “emotional behavioral abnormalities” that often precede relapse or “in A A language –stinking thinking.”  AA language has entered the Medical Profession and no one even blinked.  It will get worse.

The ASAM has  monopolized addiction treatment in the United States.   It has imposed  it on doctors through the FSPHP.  The FSPHP political apparatus exerts a monopoly of force. It selects who will be monitored and dictates every aspect of what that entails.  It is a, in fact, a  rigged game.

The Need for Regulation, Oversight, and Accountability

Accountability is necessary to prevent corruption and requires both the provision of information and justification for actions. What was done and why?   Accountability also necessitates consequences-the ability of outside actors to punish and sanction those who commit the misconduct.  Without these constraints corruption is inevitable.

In  2012 Drs. John Knight and Wes Boyd recommended the medical community outside of PHPS provide oversight and demand accountability.  As with the NC PHP audit,   Ethical and Managerial Considerations Regarding State Physician Health Programs  generated little interest from the medical community at large.

Because addiction is currently defined as a disease, addicts must be “treated” (which in the United States is more often coercive than voluntary), and “cured” (which is defined as remaining abstinent). When the disease concept is not strictly reserve for medical conditions but is expanded to any and all drug and alcohol use.

And this is how the ASAM “New Paradigm” will encroach upon others.  This is why the ACLU needs to get involved. This is not just about doctors but about the future of society.

The ASAM white paper contains the following quote minimizing the critical role of the MRO in drug testing.   They feel clinical testing is good enough.   And unless you want mandated random drug and alcohol testing at your physician visits using non-FDA approved testing with swift and certain consequences you will need to speak up.   This occurred in the medical profession rapidly and with little notice. And that is how it will occur in other venues.

Unlike forensic drug testing where the test results must be able to meet rules of evidence in administrative, civil or criminal proceedings, clinical drug testing* is part of a patient examination performed by a clinician with whom the patient is in a therapeutic relationship. The testing is used for the purposes of diagnosis, treatment, and the promotion of long-term recovery. Clinical drug test results must meet the established standards of medical practice and benefit the therapeutic relationship, rather than meeting the formal legal requirements of forensic testing. Drug testing in medicine employs the same sound procedures, safeguards, and systems of information management that are used for all other health-related laboratory tests, tests on which life-and death medical decisions are commonly made.

State Physician Health Programs have no meaningful oversight or accountability.  Across the country doctors are reporting ethical and civil rights abuses and even criminal activity to law enforcement, the ACLU and the media.  With the exception of North Carolina their complaints were patently ignored.  Feeling hopeless, helpless, defeated and entrapped many are killing themselves.   Institutional justice is a protective factor for preventing suicides.  None exists here.  The North Carolina PHP audit  revealed conflicts-of-interest and no oversight by the state medical society or board.   The audit also found that abuse could occur undetected because of this lack of accountability.

There seems to be a willful ignorance or apathy regarding PHPs.  Perhaps most take the side of the PHPs complacent that these are just helping sick doctors and protecting the public the complaints are nothing more than “bellyaching.”       In reality the misconduct and abuse perpetrated by the PHPs is commensurate with the behavior of Dr. Farid Fata,  the Detroit Oncologist who intentionally misdiagnosed patients with cancer so he could make money off unnecessary chemotherapy treatment.  Dr. Fata’s egregious betrayal of trust and unconscionable acts generated a flurry of comments.  His vile acts resulted in an appropriate response.

The exact same misconduct is being perpetrated by PHPs but being overlooked, justified or otherwise ignored.  Dr. Fata intentionally misdiagnosed patients with cancer who did not have cancer so he could give them chemotherapy to make money.   PHPs are intentionally misdiagnosing substance abuse and behavioral disorders in physicians who do not have them in order to give them unneeded treatment and force them into monitoring contracts to both make money and gain control.

It undermines the very integrity of the profession.  It is particularly vile when the betrayal of trust involves doing the opposite of what was entrusted.   Abuse of positions of power, trust and influence in the field of medicine need to be both prevented, recognized and addressed.    Oversight, regulation and accountability are essential  if this is going to be accomplished.  There are no exceptions.   Policies and procedures must be enforced in a consistent manner.

The medical boards, medical societies, and departments of health have given the state PHPs carte blanche control and absolute power.  They will not even investigate misconduct or even crimes.

And the PHPs have convinced law enforcement that this is a parochial matter.  Doctors reporting crimes are often turned back over to the PHP.

This refusal to investigate  or even acknowledge valid and factual complaints of professional misconduct has not only prevented the exposure of  wrongdoing and corruption but deepened it.    How does wrongdoing and corruption serve the best interests of the public or promote public health?  It doesn’t.    How could  a culture that protects the perpetrators of unethical and indefensible misconduct yet turns a deaf ear to their victims possibly contribute to the common good? It can’t.  And giving  an oppressive, illegitimate and irrational tyranny absolute power and granting them unrestrained managerial prerogative over doctors is fallacy.

“Every time we turn our heads the other way when we see the law flouted, when we tolerate what we know to be wrong, when we close our eyes and ears to the corrupt because we are too busy or too frightened, when we fail to speak up and speak out, we strike a blow against freedom and decency and justice.”
Robert F. Kennedy

 

aaadrugtest

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Anatomy of a Forensic Fraud: The Reality of Drug and Alcohol Testing

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The juxtaposed documents in and of themselves reveal a number of red flags.  How does one “revise” a chain-of-custody”?    If you do a google search you will not find “chain-of-custody” as an object of the verb revise. It is an oxymoron.  A document or opinion can be revised.  A chain-of-custody, by its very definition, cannot.  This collusion to fabricate a positive test has coined a new oxymoron—“revised chain-of-custody.”     Go ahead and look it up. It is a novel one.     As it should be.

What these documents show is, in fact, indefensible ethically, procedurally and legally.  The first document signed by Dr. Luis Sanchez, past President of the FSPHP and past Medical Director of Physician Health Services, Inc.  (PHS) was sent to the Board of Registration in Medicine on December 11, 2012 and is notable for two statements.   The letter from Dr. Sanchez asserts that “Yesterday, December 10, 2012, Physician Health Services, PHS received a revision of a laboratory test result,” but it did not matter because PHS was {unaware} ” of any action taken by the Massachusetts Board of Registration in Medicine as a result of the July 28th, 2011 report.   However, based on the amended report, PHS will continue to disregard the July 21st PEth test result.”

The second document, addressed to Dr. Luis Sanchez, is dated October 4, 2012 (67 days earlier) and shows the first document to be a bald-faced lie.

On July 28h 2011 Dr. Luis Sanchez reported to the Medical Board that I had a positive alcohol test.

Although I knew that Dr. Sanchez had fabricated the test I  had no way of proving it. I requested the “litigation packet,” which records “chain-of-custody” from collection to analysis in August of 2011.  At first they  refused.  PHS then tried to dissuade me (“it will be costly, involve attorneys, etc). Finally they agreed but threatened me with “unintended consequences.”

I was finally able to get a copy of the “litigation packet”  in December of 2011.  Remarkably, it  showed that Sanchez had requested my ID # and a “chain-of-custody” be added to an already positive specimen. I reported this to the Board but they ignored it. I also filed a complaint with the College of American Pathologists.Screen Shot 2014-11-06 at 11.17.32 PM

On October 23, 2012 Sanchez reported to the Medical Board that I was “noncompliant” with requirements with A.A.  meetings that I was supposed to go to as a direct result of the positive test and my license to practice medicine was suspended as a result in December 2012.

On December 10, 2012 I contacted the College of American Pathologists who told me the test was “amended” from “positive” to “invalid” on October 4, 2012. I confronted Sanchez and PHS and they said they did not know anything about it.

The following day, December 11, 2012, they sent out a letter saying that the test was invalid but that they were “unaware of any action taken against my license as a result of the test.”  

The documents show that on  July 19th, 2011 Sanchez requested my ID # 1310 and a “chain-of-custody” be added to an already positive specimen and on October 4th 2012 the test was “appended” to “external chain of custody not followed per standard protocol.”

Please note again that  Dr. Sanchez stated on December 11, 2012 that he “just learned” about this on December 10, 2012. He reported me to the Board as “noncompliant” on October 23, 2012 and my license was suspended in December 2012.   These documents show he had full knowledge that the test was invalid and as an agent of the Board this is under “color of law.”   Both he, and PHS, need to be held accountable for this.

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Lies, Lies, and More Lies

10:19:12-Verbal Compliant Noncompliance f:u written 10:19:12–BORM Complaint Committee

The contradictory documents from Sanchez alone constitute a crime (withholding information in concealment and providing false information to a state agency).  But what he did is far far worse.

I just obtained the October 4th document. Although I knew it existed, PHS suppressed it and refused to acknowledge it.   But in response to a complaint I filed against PHS and the labs it was revealed by USDTL that the test in question (phosphatidyl-ethanol) was not sent as a “forensic” specimen but collected as a “forensic” specimen, then changed to a “clinical” specimen at the request of PHS Program Director, Linda Bresnahan.   The specimen was kept at the collecting lab (Quest) for 7 days as a  “clinical” specimen, then sent to the analyzing lab (USDTL) with specific instructions from Quest to process it and report it as a “clinical” specimen.  PHS then used it as a “forensic” specimen by reporting me to the Board of Registration in Medicine and  requesting I undergo an evaluation for alcohol abuse.

As a “clinical” specimen it is rendered “Protected Health Information” (PHI) and thus under the HIPAA Privacy-Rule.   So with the help of the College of American Pathologists I requested my PHI from both Quest and USDTL. Quest refused (for obvious reasons) but USDTL complied.   And that is how I was able to obtain the October 4th document revealing that Dr. Sanchez lied to the Medical Board.     I would love to hear him, or PHS MRO Wayne Gavryck, defend the indefensible (and unconscionable).

Dr. Sanchez is correct when he pleads ignorance of any action taken by the Board as a result of the July 21st PEth result.   It was his report to the Medical Board  that I was “noncompliant” with attending AA meetings (that I was supposed to go to as the direct and sole result of the positive test)   that he reported to the Board just two weeks after the October 4th appended test.

The test was sent as a “clinical” specimen intentionally. PHS is not a clinical provider but a monitoring agency. They cannot send clinical samples.   But since clinical samples are “protected health information” and under HIPAA the lab had to give me the records and here you have them.

The distinction between “forensic” and “clinical” drug and alcohol testing is black and white.  PHS is a monitoring program not a treatment provider.  The fact that a monitoring agency with an MRO asked the lab to process and report it as a clinical sample and then used it forensically is an extreme outlier in terms of forensic fraud.  The fact that they collected it forensically, held it for 7 days and changed it from “forensic” to “clinical” to bypass strict “chain-of-custody” requirements  deepens the malice.  The fact that they then reported it to the Board as a forensic sample and maintained it was forensic up until now makes it egregious.   But the fact that the test was changed from “positive” to “invalid” on October 4th, 2012 and Sanchez then reported me to the Board on October 23rd 2012 for “noncompliance,” suppressed it and tried to send me to Kansas for damage control makes it wantonly egregious.   (they didn’t think I’d ever find out).

Add on that the fact that I’ve been questioning the validity of the test since day 1 and they violated the HIPAA Privacy Rule over and over and this is reckless and major health care fraud.

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Fax from PHS to USDTL on July 19th, 2011 asking that my ID #1310 be added to an already positive test and a “chain-of-custody” be “updated”

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USDTL complies with PHS request to and adds my ID #1310 and a date of collection (July 1, 2011) to an already positive specimen

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No date of collection, no unique identifier linking specimen to me. Multiple “fatal flaws.”

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I file complaint with CAP January 12, 2102. CAP forces USDTL to amend test from “positive” to “invalid” which they do on October 4, 2012. PHS conceals this fact until December 11, 2012

Letter from Chief of Toxicology at MGH–Ignored by PHS, USDTL, and the BORM         11:5:12-Dr. Flood Letter–Ignored by PHS:USDTL:BORM

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Physician sues Quest Diagnostics for forensic drug test fiasco

Massachusetts physician Dr. Michael Langan has filed a lawsuit against Quest Diagnostics, alleging the lab giant was negligent and engaged in fraud and deceit in its handling of his forensic drug test sample.

http://pathologyblawg.com/pathology-news/pathology-vendors/quest-diagnostics/physician-sues-quest-diagnostics-forensic-drug-test-fiasco/?utm_source=rss&utm_medium=rss&utm_campaign=physician-sues-quest-diagnostics-forensic-drug-test-fiasco

Robin Williams Melancholy Suicide–Hopelessness, Helplessness, and Defeat

 
 
There’s something in his soul
O’er which his melancholy sits on brood,
And I do doubt the hatch and the disclose
Will be some danger—which for to prevent,
I have in quick determination……..
It shall be so.    Madness in great ones must not unwatched go.
—Hamlet Act III, Scene 1
According to Radar Online Robin Williams is looking “grim and focused.”  Grim? Yes. Focused? No.  His visage is one of entrapment, despair, and dread.
In  F. Scott Fitzgerald’s  The Great Gatsby, Nick Carraway observes that “the loneliest moment in someone’s life is when they are watching their whole world fall apart, and all they can do is stare blankly”   This is not focus but melancholia–hopelessness, helplessness, and defeat.
In 1896 Émile Durkheim described “melancholy suicide” as being “connected with a general state of extreme depression and exaggerated sadness, causing the patient no longer to realize sanely the bonds which connect him with people and things about him. Pleasures no longer attract.”  Williams’ face  is weighted with melancholy. Not focus.

Heightened perceptions of defeat and entrapment are known to be powerful predictors of suicide. According to the “Cry of Pain” model people are particularly prone to suicide when life  experiences are interpreted as signaling defeat, defined as a sense of a “failed struggle.” Unable to find some sort of resolution to a defeating situation, a sense of entrapment proliferates and the perception of no way out provides the central impetus for ending one’s life.

As in all suicidal tragedies, the role of addiction and mental illness has been posited as the cause. Although depression and substance abuse are the two biggest risk factors for suicide, neither explains  completion of the act–the descent from ideation and planning to finality and oblivion.  Saying suicide is caused by depression and drugs is like claiming marijuana is a “gateway drug” to heroin.  It may be a a common related  pre-conditional occurrence but it is not the cause.  It is a non sequitur.   And just as most marijuana users never develop an inclination to stick an opiate filled needle into their veins, the majority of depressed individuals and substance abusers do not kill themselves.   One does not lead to the other.

And as we have seen in the reports of bullied teenagers who have died by suicide, it is all too often the bullies themselves who are quickest to pronounce this conclusion.   Attributing suicide to mental illness and substance abuse deflects culpability.  It negates the need for further inquiry.  It creates an absence of the need to change.   The rationalization diffuses both individual and collective blame.   It scatters  responsibility and guilt.  It is both an individual and community defense mechanism.  Incessantly and chronically shaming, humiliating, and degrading another person because of race, body type, sexual preference or whatever perceived eccentricity or non-conformity threatened the community herd was irrelevant.  It played no role.  It was drink, drugs, or depression–the unspoken understanding is  they would have done it anyway.   And no one stops to ponder that said depression or desire to alter ones mental state just might in actual fact be a symptom of the humiliation and shame they themselves created.   And it works.  The bullies are never held accountable. But it is nevertheless they who figuratively loaded the gun, placed it in the victims mouth, and pulled the trigger.

The  link between bullying and suicide is well known,  especially when combined with entrapment and the feeling there is no way out.  “They would have done it anyway.” No, they would not have and a modicum of perceived support, concern, kindness and understanding  from others may have prevented it.

Dr. Drew Pinsky seemed omnipresent in discussing Williams suicide; delivering authoritative pronouncements with seeming omniscience and certainty.     “The death of Robin Williams has led me to this plea — let’s loudly and seriously address something that’s still hidden, stigmatized and even ignored in this country: Mental illness,” Pinsky writes on his blog.  I don’t see the logic here.  How is exposing mental illness a product of Williams suicide.  He was  open, unashamed, and forthright about his prior addictions and depression.  He was not hiding it.  Neither is the 21st century for that matter.

The more important issue that I see needs pleading, is that mental illness be properly, accurately, and thoughtfully diagnosed and treated.

Depression, as with any mental illness, needs to be diagnosed, monitored, and treated by educated, trained, and experienced experts in depression.   Not self-proclaimed experts.     Pinsky’s specialty is “addiction medicine” and he is “board certified” by the American Board of Addiction Medicine (ABAM).

The American Society of Addiction Medicine can trace its roots to the 1954 founding of the New York City Medical Society on Alcoholism (NYCMSA) by Ruth Fox, M.D.,  whose husband died from alcoholism. This  group promoted the concept of alcoholism as a chronic relapsing brain disease requiring lifelong spiritual recovery through the 12-steps of AA. And the primary goal of the ASAM is and always has been the acceptance of 12-step doctrine, lifelong abstinence, and spiritual recovery as the one and only treatment for addiction.  It always will be.

This philosophy and guiding doctrine stems from the “impaired physician movement”, a group that,  according to British sociologist G.V. Stimson: ” 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.”  This group grew in numbers, organized, and eventually became the ASAM.

The American Board of Medical Specialties (ABMS)  recognizes 24 medical specialties and subspecialties. Addiction Medicine is not one of them. The only ABMS recognized subspecialty is Addiction Psychiatry and it requires a four-year psychiatric-residency program followed by a 1-year Fellowship focusing on addiction in an accredited training program.

In contrast, ABAM certification requires only a medical degree, a valid license to practice medicine, and completion of residency training in ANY specialty.

Hazelden, the facility where Williams was admitted in July is an ASAM facility.  And the  Medical Director, Marvin Seppala is a Like-Minded Doc.   Unlike most ASAM physicians, however, Seppala is a psychiatrist. But he is a psychiatrist brought up in the folds of ASAM ideology. He was, in fact, the first adolescent graduate of Hazelden in the 1970s when he completed the program at the age of 19.

Pinsky, predictably goes on to state that “Williams had a brain disease, ” He posits it against demons or devils as if it is either/or.  This concrete splitting of complex subjects into two separate entities to claim only one correct is just one of many simplistic and misleading “false dichotomies” used by the ASAM.     Of course addiction is a brain disease.    But in reality the definition is unhelpful unless we are living in the Victorian era. It’s like saying Gonorrhea is a genital disease  not  venereal (from Latin venereus “of sexual love”).  In reality it involves a number of factors including both psychosocial and medical.  Cornering a definition does nothing to advance knowledge and care.

Addiction is multifactorial and diverse. Simplifying it into binary options does little to advance understanding.   And it too involves a variety of issues including the situational, the psychosocial, the genetic and the biochemical.   Like every other medical issue there are a number of factors to be taken into consideration.  And imposing the 12-steps to salvation on all-comers is not only illogical, but anti-science, and downright improper.    It can also be deadly.  Especially when the the person it is imposed on is not a full-blown addict but a substance abuser. an experimenter, a dabbler, or someone who has simply had a “lapse.”

The ASAM emphasizes that addiction is a “brain disease” and not a “moral failing” in a mutually exclusive construct that allows either one or the other but not both.  It is presented as a dichotomy in which the promotion of one both precludes and dismisses the other.  It is either black or white. Period.

But substance use, abuse, and addiction comes in every color, saturation, hue and shade.   Psychosocial, behavioral, and social factors play a role in the actions and deeds of everyone including those addicted to alcohol and drugs.  The disease concept neglects this multifactorial confluence of factors that ultimately produce a given behavior by viewing all behavior a product of the “disease.”   Any and all behavior is simply a product of a “brain disease” in the addicted individual who cannot be trusted to make decisions on his own but has to be told what to do as part of the treatment.   A danger to himself and others  the addict cannot be trusted to make his own decisions, so we must make them for him.

The chronic brain disease model is an oversimplification of the complex and a false dichotomy–so too is bifurcating  “recovery” and “relapse,” treatment” and  “discipline,”  and “confession”and “denial.”  Anything less than total abstinence constitutes an illness.

One true dichotomy  that exists among the proponents of the chronic brain disease model of addiction with  lifelong abstinence and spiritual recovery is  a  person is either “with them” or “against them.”

Dr. Drew Pinsky notes “there were a number of factors” that contributed to William’s condition.  He states “alcoholism is certainly one. He may have had a genetic potential for depression. Addiction and depression can be an easily fatal combination.”    Non-sequitur.

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Depression needs to be treated by thoughtful, educated, competent and trained experts in depression not self-declared experts.    ASAM doctors are not “real” experts.  They are pretend experts trumpeting one frozen paradigm while dismissing or ignoring others.  It is expert opinion where the goal is not new knowledge and and new discovery. The die  is cast.  And most of the “research” put out by this group consists of methodologically unsound studies published in their journals in which an attempt is made to make the data fit an already determined hypothesis.

Point being that depression needs to be evaluated and treated by trained professionals who understand depression. Psychiatrists, psychopharmacologists, neuropsychologists, and psychologists schooled in a broad spectrum of treatment modalities.   Numerous depression treatments are available.  If one treatment fails or is ineffective then others must be tried.    Most depression is treatable, especially subacute or acute depression.  SSRIs, SNRIs SNDRIs, tricyclics, MAOs, and atypical antidepressants are available. Different types of psychotherapy are available–cognitive behavioral therapy, interpersonal therapy, dialectic behavioral therapy, mindfulness therapy, and Jungian psychoanalysis can be beneficial for people suffering from depression.  And ECT and TMS can also play a role in depression refractory to medications and psychotherapy.

Depression is extremely common in Parkinson’s disease but due to the dopamine loss it requires special consideration of what drugs to use and not use.  SSRI’s can sometimes worsen the condition.   Consultation with a knowledgable and experienced neurologist is critical.

I do not know what assessments or treatments were being tried in Robin Williams.   But the treatment modalities offered by ASAM physicians are usually few to one.

The majority of “addiction medicine” specialists are not psychiatrists.   For all you know you may find yourself being treated by an addiction  “specialist” who was a practicing proctologist just a few years prior; and perhaps not even a good one at that.

Moreover, many of the ASAM physicians are “anti-medication” and may take people off medications that have been helping them and that they need.   And the devastating results are often  seen after the patient has been discharged home.

Taken off drugs while in rehab and sent home without them, the beneficial effects may wear off gradually. And as they do mental conditions may deteriorate.   Manic episodes, paranoid psychoses, extreme anxiety, and profound depression can all occur well after someone has been discharged home.   So can suicide.

And when this happens the ASAM doctors  blame it on their fatal “disease” when, just as is seen with the suicides of bullied teens, it was actually they  who put the gun to their heads and pulled the trigger.

Depression needs to be treated by experts in depression.   Putting someone in a one-size fits all shackled and frozen mold can be fatal.  And calling them  helpless addicts with a chronic disease who have no control due to character defects adds kindling to the fire.  Depressed people need empowerment not powerlessness;  self-esteem not shame.  Shame is devastating. It goes right to the core of the person’s identity making them feel exposed, inferior, and degraded.  Dehumanized, delegitimized, and vulnerable.  The link between bullying and suicide is clear.  And this is especially true when combined with entrapment.  The feeling there is no way out.

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.   And it can be fatal.

Under a dictatorship everything else becomes subordinated to the guiding philosophy of the dictatorship.   Corresponding doctrine replaces ethics as well as professional guidelines, standards of care, and evidence based medicine.  Ideology usurps critical thinking.  Having only a hammer, everyone is seen as a nail  A symphony with just one note.

And faith in institutions demands mass adherence to faith in that authority. Direct challenge to the status quo undermines the publics blind faith. The biggest obstacle is thimages-4at this system allows them to throw the normal rules of conduct under the imperative of a higher goal assumed to trump all other consideration.

All of medicine needs to be predicated on competence, thoughtfulness, good-faith, civility, honesty, and integrity. This is universally applicable.  All specialties of medicine are required by that specialty to practice evidence based medicine and avoid conflicts of interest except one–addiction medicine.  Due to a confluence of factors they have been given a pass.

But the validity and reliability of opinions lie in their underlying methodology.  Reliance on the personal authority of any expert or group of experts is a logical fallacy.

And in order to save American Medicine this  problem needs to be clearly recognized.  The ASAM has a monopoly on addiction medicine. Treatment of substance abuse in this country is, in fact, defined by the impaired physicians movement paradigm.

A paradigm that is in actuality rife with methodologically flawed studies, cherry picking, bias, and cognitive distortion.  A paradigm that places expert opinion, ideology, and doctrine above critical thinking and evidence base.   Coercion and control are placed above patient autonomy and individual choice because the patient has a “disease” and can’t think for himself.  So we’ll think for him.    The  conflicts of interest are many and complex. They would be unimaginable in other fields of medicine.

But  I agree with Pinsky on one point.  His  comment that addiction and depression can be a deadly combination is true.   And this is especially so when treatment of the addiction is the primary focus and consists of imposed 12-step indoctrination and the depression remains untreated or ineffectively treated.    That is a deadly combination indeed–and one that can easily lead a person down the road of hopelessness, helplessness, and despair. And it is time the medical field as a whole shined some light on this, and hold addiction medicine to the same standards of conduct and care as the rest of the profession.

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A Golden Age

BY TIMOTHY STEELE

Even in fortunate times,
The nectar is spiked with woe.
Gods are incorrigibly
Capricious, and the needy
Beg in Nineveh or sleep
In paper-gusting plazas
Of the New World’s shopping malls.
Meantime, the tyrant battens
On conquest, while advisers,
Angling for preferment, seek
Expedient paths. Heartbroken,
The faithful advocate looks
Back on cities of the plain
And trudges into exile.
And if any era thrives,
It’s only because, somewhere,
In a plane tree’s shade, friends sketch
The dust with theorems and proofs,
Or because, instinctively,
A man puts his arm around
The shoulder of grief and walks
It (for an hour or an age)
Through all its tears and telling.

Timothy Steele, “Golden Age” from Sapphics and Uncertainties: Poems 1970-1986. Copyright � 1986, 1995 by Timothy Steele. Reprinted with the permission of the University of Arkansas Press, www.uapress.com.

Source: Sapphics Against Anger and Other Poems (1986)

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Disappointed that his grandiose proposal to test the urine of half the U.S. population for illicit drugs was declined in the 1980’s, Bob realizes such a large swath was too tall an order. Acknowledging that his dream of lifelong urine drops for each and every one of the riffraff at least once a fortnight will take time, he decides to focus his attention on specific subsets of the great unwashed such as school-children, welfare mothers, the unemployed and whatever they are calling Hippies these days.

Medical Urban Legend–The Legacy of the 4 MDs and why B.S. Needs to be Identified from the Get-Go!

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“Because I can Biotches! That’s right..because I can!” 

According to G. Douglas Talbott, rehabilitation programs that evaluate and treat the rest of the population for substance abuse issues are incapable of doing so in doctors as they are unlike any other inhabitants of our society.   Physicians are unique. Unique because of their incredibly high denial”, and this genetically inherent denial is part of what he calls the “four MDs.” Used to justify the thrice lengthier length of stay in physicians the “four-MDs” are as follows: “M-Deity”, “Massive Denial” “Militant Defensiveness” and “More Drugs.”

He states that “Impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.”
Now some  doctors are arrogant undisciplined egotists but narcissistic personalities exist in any profession and expanding traits that may apply to a small percentage of doctors to include all doctors as a universal truth contradicts reality. Applying a stereotypical paternalistic length of treatment in doctors three times as long as non-doctors to force a “one-size” fits all treatment on them has no evidence base.

tumblr_kuwuugSEmN1qz6z0no1_500This dicto simpliciter argument can, in fact, be refuted simply by pointing it out! Sadly, no one ever did so the ASAM front-group hasbeen able to establish this caricature of the arrogant paternalistic know it all needing 3 months or more of treatment as standard of care for our profession. They did this by getting medical boards and the FSMB to accept fantasy as fact by relying on board members tendency to accept expert evidence at face value–which they always do and that is a personality characteristic that I would argue is not dicto simpliciter.

Physicians are unique only insofar as the unique elements required of the profession to become and be a physician such as going to medical school and completing the required board examinations.

Any and all doctors referred to a PHP for assessment will spend at least 3 months in treatment if the facility feels it is indicated. It is inevitable. No one has challenged a patently absurd generalization that has absolutely no evidence base or plausible scientific or medical explanation. Of course those sentenced to the 3 or more months have complained but by that time they are de-legitimized and stigmatized. No one to complain to.  After all, these are just redeemed altruistic non-profit  good guys protecting the public and helping colleagues forge a path to salvation!
All the ASAM/FSPHP quacks have to do at that point to deflect legitimate concerns is point out the one doing the complaining is an “addict” who is “in denial” and it is part of his “disease.”  The mere accusation of substance abuse is used to disregard the claims of the accused.
Authoritative opinion entrenched. Someone should have called B.S. long ago.  But no one did and if they had we would not be in the current situation which is only going to go from bad to worse as the ASAM plan for universal contingency-management and urine usury unfolds-–A “golden age.” And the 4MDs Talbott attributes to doctors are all wrong. There is only one MD and it is “medical license.” On second thought that may not be entirely true.  “More money” may be another. And I am not talking about a doctor’s income. I am referring to insurance and the specter of depleting home and hearth.   Fiscal annihilation. Your license or your life.   And the only true  and plausible answer that Talbott could give to justify the lengthy stay is “Because I can biotches!” And “contingency-management” sounds better than extortion doesn’t it?  And  using your medical license as “leverage” sounds a helluva lot better than holding it for ransom.
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The ‘A’ Word: Are Doctors Arrogant?
Leslie Kane
June 17, 2014
Good Doctors Have Some Bad MomentsDoctors’ personalities have become a hot topic, not only because warmth and pleasantness count toward patient satisfaction, but also because positive patient interactions have a role in better outcomes.Physicians’ personalities are under the microscope as patients post reviews of doctors on numerous Websites. In some reviews, the word “arrogant” has shown up. But calling doctors arrogant is nothing new.Are there really so many arrogant doctors? No doubt, some physicians deserve the label, but it seems to be a stereotype that has blossomed and taken on its own life.”Arrogance among doctors is not the norm”, says Marion Stuart, PhD, co-author of The 15 Minute Hour: Therapeutic Talk in Primary Care, and Professor Emeritus in the Department of Family Medicine at UMDNJ-Robert Wood Johnson Medical School. “Someone who has done the hard work and has gone into medicine because they care about people, and are interested in helping peoples’ lives and making the world a better place, is not going to be arrogant.”So how did the arrogant doctor epithet arise?In the past, doctors were considered authorities who told compliant patients what to do and treated them with a paternalistic attitude. Some doctors may retain those behaviors today.Another possibility is overgeneralizing. A patient sees a doctor who has a difficult personality and assumes that the trait is more widespread within the profession than it really is.

Arrogance or Self-confidence?

“Arrogance is totally different from self-confidence,” says Dr. Stuart. “When you’re confident, that’s your assessment of your own competence. You have the experience and the wisdom, you know what you can do, and your confidence says that. It’s your relationship to yourself and your own expertise,” she says.

Arrogance is a different ballgame. “This has to do with your judging that other people are inferior,” she says. “It has more to do with not seeing other people as being up to your standards.”

Could the confidence that comes with being accomplished and successful make someone arrogant? Typically no, says Dr. Stuart. The trait of arrogance develops or resides within a person at a much earlier stage, arising from one of two paths:

“I am indeed better.” Someone who has always lived a privileged life, feels entitled to all of the finer things, or has always been looked up to may take it as a given that he or she is better than others. “People who had a sheltered, protected existence with no perception of what the real world is like for other people may consider themselves an elite group, entitled to feel superior,” says Dr. Stuart.

“I made it, so why can’t you?” By contrast, a person who was deprived as a child and worked very hard to pull himself up by the bootstraps may then look down on others who don’t have the same perseverance or initiative to take charge of their life and create similar success.

Doctors Are Harried and Pressured; Patients Are More Demanding

Some doctors have admitted that at times it’s hard to maintain their patience, and frustration triggers a snappish response. Throw into the mix the fact that doctors may have less time to see each patient and answer questions, and you have the ingredients for a negative interaction.

“I’ve had eight years of medical education and I’ve been trying to get my patient to make healthy lifestyle changes, and he comes in with a page ripped out of a tabloid, convinced that the information is right…there’s a limit to how much time I can spend ‘educating’ or convincing them that their ‘cure’ has no scientific basis,” one physician told me.

People have come to expect the stance of “the customer is always right” and get annoyed if doctors don’t accede to all of their requests. But because of new medical practice guidelines, a doctor may not readily give the patient the test or medication they ask for. “Now, with healthcare insurers and companies setting limits on doctors, many times the patient feels that the doctor is not so much on their side, and this could be perceived as arrogant,” says Dr. Stuart.

Is There an Outbreak of Rudeness?

Barry Silverman, MD, a cardiologist and coauthor with pediatrician Saul Adler, MD, of Your Doctors’ Manners Matter: Better Health Through Civility in the Doctor’s Office and in the Hospital, says, “While most doctors are appreciated and respected by their patients, there’s a general perception that professionalism has declined.

“Patients are often more informed, ask detailed questions, and demand a high level of service, while demands on the doctor’s time increase and reimbursements fall,” says Dr. Silverman. “What patients interpret as arrogance is many times a rushed and harried doctor, not an uncaring one. Medicine can be mentally and physically exhausting, but the bottom line is that the doctor must listen and communicate with the patient to deliver quality medical care.”

Still, remaining pleasant and calm is easier for some doctors than for others. There’s no uniform physician personality; many doctors have a natural “people person” inclination, while others are more stoic.

Are doctors expected to smile and be nice in every circumstance, no matter what?

“Professionalism is not about putting on a happy face or being someone you are not; it is about providing quality care for the patient,” says Dr. Adler. “Patients are more informed and have access to more information than ever before. Much of that information is incorrect and sometimes harmful. That means that part of the professional duty is to teach as well as treat.

“Patients understand that doctors have significant restraints on their time, and it is not unreasonable for doctors to use preprinted written materials, educational resources outside the doctor’s personal office, and honest and informative Websites,” says Dr. Adler. “However, under no circumstances should the doctor be rude or abrupt; a smile and kind, considerate behavior is always appropriate.”

It would be naive to say that there aren’t arrogant doctors. But there are far more doctors trying to do their best for patients and relate to them.

Medscape Business of Medicine © 2014 WebMD, LLC

The Addiction Medicine Control Machine

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In his 1969 novel The Wild Boys, William S. Burroughs writes “Under pretext of drug control suppressive police states have been set up throughout the Western world…. The police states maintain a democratic façade from behind which they denounce as criminals, perverts and drug addicts anyone who opposes the control machine.”

15 years earlier Dr. Ruth Fox formed the New York City Medical Society on Alcoholism. This organization subsequently became the American Medical Society on Alcoholism and eventually the American Society of Addiction Medicine.    The goal has always been to convince the medical establishment that 12-step recovery is the one and only treatment for alcoholism and drug addiction.

Unable to convince the medical establishment of this they decided that a better tactic would be to impose it on them.

And through propaganda, misinformation, lobbying, misleading public relations, and myriad other machinations used to promote a static ideology and suppress anything that contradicts, detracts, or otherwise not fit their world view as a product of themselves, they have admittedly succeeded.

This  includes creating a  “medical specialty” that requires neither knowledge nor competence.  Like Grimm fairy tale number 98, Doktor Allwissend (Doctor know-All) in which a poor peasant becomes a famous medical expert by declaring himself so ( by dressing like an expert, brandishing an ABC book with a rooster on the front, and having a sign painted with the words ‘I am Doctor Know-All’ and nailing it above the door to his house), the ASAM has “faked it til they made it.”

To make this point I sat for the exam with absolutely no preparation in 2010, passed by a respectable margin, and was “board certified” in addiction medicine. ABAM “board certification” is not recognized by the American Board of Medical Specialties (ABMS).  It is a “self-designated” medical specialty which means exactly what it sounds like.  “I hereby declare myself..”

Except for a year of psychopharmacology research, some MRO work, and “moonlighting” at local mental health facilities I have no education or training in addiction yet I was able to join the ASAM fold—–an exercise somewhat like showing how easy it is to buy a gun at Walmart.  The analogy does not end there however as they can both be “licenses” to kill.

Like  an NRA wallet card I never intended to use it.  I let it lapse so there is no need for the ASAM to revoke it.    It was in effect an  “academic exercise” to make a point-and that point being that I am no “expert” in addiction medicine and neither is 4000 of me.

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By proclaiming themselves the cream of the crop, bestowing phony “board certification,” and creating the myth of expertise at the expense of the real experts and lobotomizing evidence based thought and critical thinking they have created a monopoly of despotism in addiction medicine treatment.  The ASAM and FSPHP  have created a tyranny in regulatory medicine that is unsupervised and opaque.  Moreover, they have grand plans for the rest of the population. They have influenced the DSM-V, are trying to gain control of MRO education and regulation, and pose a great danger to all of us.  This front-group for the 12-step assessment and treatment centers and the drug and alcohol testing industry is indeed fulfilling Burrough’s prediction of a police state.

They have money and and a monopoly of force by number (they outnumber Addiction Psychiatrists by 4:1) and the risks of this unqualified authoritarian control and influence involve all of us as a society.  And it impacts freedom, life, and liberty.

Alarmist call to arms about the dangers of drugs and hidden addicts protected by others and posing danger to create untrue hype is propaganda and misinformation to further the ASAM drug-testing 12-step inpatient rehab agenda and gain control. Drug war sloganeering designed to get everyone aboard. Logical fallacy, deceptive facts, pseudoscience, and misinformation is obvious if anyone cares to look a little deeper. The conflicts-of-interest are immense. The ASAM and FSPHP are front-groups that use ends-justifies-the-means coercion and deception to get public recognition of the righteousness of the twelve steps of recovery.

Neither doctors nor US citizens should be subject to the whims of a religion based political group composed of unqualified, inexperienced, paternalistic and biased individuals who are truncheons of dogmatic ideology and refuse to accept evidence based treatment, transparency, and accountability as important. ASAM board certification is not recognized by the ABMS. These are self-proclaimed specialists–great pretenders.   Underneath is a Potemkin village.  The emperor is bereft of all clothes.

The problem is that regulatory agencies, politicians, medical boards, and others have bought into the lie. Most people take them at face value resulting in the perception that they are indeed experts in addiction medicine and they are well on the way to becoming the only experts in addiction medicine. Within the next couple of years this will become a reality. The ASAM will shortly gain ABMS specialty certification. They are well funded.

The addiction psychiatrist subspecialty has already being pushed into a corner. Some have even joined in in rather than fade away–kind of like what happened to the proctologists as the gastroenterologists moved further up. But that analogy doesn’t quite work  as gastroenterology swallowing proctology represents an advancement in science.  Medicine, like all of science is fluid. What they represent is frozen.  Additionally it’s a lucrative gig.

This situation is more like the anti-vacciners parading themselves as experts in immunology and gaining enough support to run out the real McCoy.

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 Pseudoscience, groupthink, deception, and coercion. A framework not built on the scientific method, evidence based decision making, autonomy and benevolence; but based on unproven ideological dogma, righteous inflexible worldview, rigid rules, obedience, and control. Drug testing of all physicians will be done by ASAM, FSPHP physicians. They will demand prohibition, testing, and treatment and will be in complete control. Even with 100% specificity and sensitivity there are valid arguments against this. But if you throw in the corruption and other issues that are obvious if one looks, then medicine as we know it is going to be lobotomized by dabblers and clowns.

It will come in a whimper not a bang and by then it will be too late. The goal of the ASAM has been to be recognized as the “experts” in addiction medicine ever since The American Society of Addiction Medicine (ASAM) was started by Dr. Ruth Fox in the 1950’s to promote AA and the 12-steps to doctors as a treatment for alcoholism.

PHP’s function to monitor and control. . Mandating coercive 12-step ideology onto physicians is SOP. The marked rise in physician suicide over the past decade is directly correlated with the FSPHP taking over state impaired physician programs. And the “kill em all let God sort em out” logical fallacy of saving doctors and protecting patients is propaganda with no evidence base.

This system, that encourages referring doctors confidentially for evaluation, is a nearly foolproof means to silence any physician they feel the need to. An accusation of substance abuse is made relatively easy. Then recommend an evaluation to one of your own people who will confirm the problem and force them into a 5 -year monitoring program where you must abide by the twelve step road to salvation.

By colluding with a short list of inpatient drug treatment centers such as Hazelden, Talbott, Marworth, Farley, and others where co-conspirators there will engage in “confirmatory bias” and “confirmatory distortion” to make the assessment fit the diagnosis they have a nearly perfect system to remove any physician from practice. It is “political abuse of psychiatry.”

 

In the former Soviet Union during the Khrushchev-Brezhnev era, the KGB used its forensic psychiatric institutions to brand, arbitrarily and for political reasons, large numbers of political dissidents as suffering from “schizophrenia” and “paranoid psychosis” and then incarcerated them for long periods in “special psychiatric hospitals.” In 1976, the Soviet Union was severely censured on this account by psychiatrists from all over the world at a conference in Hawaii of the World Psychiatric Association. Only after Gorbachev’s rise to power were these errors rectified. We have now discovered that similar practices have also occurred in certain parts of China.”1– Jia Yicheng (China’s top forensic psychiatrist), 1998

 

 

Well to quote Zoolander “Earth to Mathilda” it’s occurring right here in the U.S. of A. but they have substituted “substance use disorder” for “schizophrenia” to delegitimize, marginalize, and ignore.

The ASAM claims an 80% success rate. If you look at the data they are basing this on it is illusory–sloganeering and propaganda with no substance.

The biggest obstacle is that this system allows them to throw the normal rules of conduct under the imperative of a higher goal assumed to trump all other consideration. Those outside of the FSPHP, ASAM system either defend or ignore the reports of ethical and criminal violations, complacent in their trust of these “experts” claiming they are just helping sick doctors and protecting the public.

The ASAM and FSPHP are gaining power and expanding in scope. They have effectively muscled forth the “war on drugs’ agenda to further their goals by establishing a system that of coercion, control, secrecy, and misinformation. The first wave was substance abusers, they then added any psychiatric diagnoses, then the disruptive physician”, and the next target is the “aging physician”.  Goodbye Dr. Welby.

The testing of physicians will inevitably include EtG and PEth—tests that Alabama PHS Director and ex-felon Greg Skipper introduced, proselytized, and brought to the drug testing industry like a carnival huckster. Introduced as  Laboratory developed tests (LDTs) to bypass FDA approval and regulation this junk science was commercialized, marketed, and paraded as scholarship.  Introduced with an arbitrary cutoff point of 100 it ruined countless lives.  God knows how many suicides were caused by this prohibitionist profiteer.

A 2011 study revealed that hand sanitizer alone can result in EtG levels c lose to 2000 ng/ml.

Dr. Skipper and Robert Dupont, are now recommending PEth as a confirmation test for an elevated EtG.

The evidence base is empty. Anecdotal reports supporting these tests and mostly done with Skipper as a co-author are essentially all that exist.

The June 2013 journal “Alcoholism: Clinical and Experimental Research”contains an article coauthored by Skipper and DuPont , Greg Skipperand Robert Dupont looking at 18“subjects” who tested positive for EtG and concluded that “positive PEth testing following positive EtG/EtS results confirm recent drinking.”Although they were unaware of it, these “subjects” were physicians enrolled in the Physician Health Program.

This is a system that oppresses physicians and is about to enter the domain of individual freedom, destroy the Bill of Rights, force 12-step philosophy and erode freedom of religion, stifle freedom of speech, and take us back decades.. They have convinced medical societies, medical boards, regulatory agencies, parole boards and others to not only accept them as experts, but to write legislation in states to declare them “the” experts in addiction medicine. They did this with a torrent of strategic lobbying efforts on behalf of the 12-step addiction treatment industry towards the AMA (and indirectly through the FSPHP towards the AMA), ABMS, APA, FSMB, ABIM, JCAO, CSAT, consumer groups, presidential candidates, state medical societies, congress, corrections agencies, social service agencies, faith-based community centers, the media and many other targets.

By convincing others of their expertise they have strategically placed themselves in a position of power that includes the ability to remove any doctor from practice.

“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).

And unless something is done soon, every physician in the US will be at risk of losing everything at the whim of of a 12-step front group that places ideology above evidence base and dogma above virtue.

Claiming success they now want to bring it to you. Take a look at Robert Dupont’s keynote speech before the Drug and Alcohol Testing Industry Association.  Prohibitionist profiteers euphoric about the future bumper crop of clear cups and urine. “Test em all” Dupont wants to include schools and children in the net.  Reminiscent of the Nuremberg rallies he received a a thundering standing ovation.    And for this to happen all you have to do is one thing-nothing.

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