The Need for Anti-Trust and OIG Investigation of Physician Health Programs—Sunshine is the Best Disinfectant!

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


Unknown-3An article published in the March 17, 2014 newsletter Alcoholism and Drug Abuse Weekly entitled “Physician group urges focus on spiritual and psychosocial” describes a group of doctors emphasizing “that for all addictions, the psychosocial and spiritual interventions, including 12-step interventions must be included in the treatment process.”   “According to founding board member Dr. Ken Thompson, M.D., “to not do so falls short of practicing good addiction medicine.”
With a “significant percentage” in 12-step recovery themselves, “they have formed group called “Like-Minded Docs.”  This group now has close to 300 physicians, “many of whom are medical directors of top treatment programs and also members of the American Society of Addiction Medicine (ASAM).”

ADAW March 17 2014

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Dr. Thompson is  the Medical Director of Caron treatment center in Pennsylvania. The group also includes medical directors of many other treatment centers including Hazelden, Talbott, Marworth, and Promises.   The President of the American Society of Addiction Medicine is in fact a Like-Minded Doc.

The number of like-minded docs represent over 10% of the American Society of Addiction Medicine (ASAM).
Ostensibly I applaud the ideal of addressing the psychosocial and spiritual aspects of addiction.

I also acknowledge that alcoholics anonymous and 12-step recovery is a treatment tool that can provide great benefit to some people.   But to others it provides no benefit and to some it can cause harm.   As most reasonable people would agree, forcing individuals into a thought process of spirituality should never be mandated.

That being said, I have no strong feelings for or against A.A and 12-step spirituality.  I view it through the same pluralistic and open-minded lens as I do religion–there are many paths to salvation and none superior.

I have referred patients to A.A. and see it as an option and a personal choice that can provide great benefit to some people, none to others and in fact harm those who are not aligned with the concept.

If it works for you great. If not then let’s take a different approach.
Although the ideals of the Like-Minded Docs are laudable, it is the framework that is concerning as it creates a confluence of currents that preclude option and choice.

It is a scaffold that can be used for coercion, control, and imposition.   It can be abused.

And this is exactly what is being done in many of the State Physician Health Programs (PHPs) as well as the drug courts.  It is notable that many of the same individuals pushing PHPs as a  “replicable” model of recovery are the very same individuals behind the drug courts and the motivation behind this does not appear to be altruism but power and greed.

Originally funded by state medical societies and staffed by volunteer physicians, PHP’s were designed to help sick doctors and protect the public. Over the past decade these programs have undergone a sweeping transformation due to this subgroup of the  ASAM.

It is important to understand that the ASAM is not recognized by the American Board of Medical Specialties (ABMS). They created their own “board certification” (ABAM) and the only requirement is an M.D. in any specialty and some sort of experience in substance abuse.  This is not a medical specialty but a “special interest group.”

images Trumpeting the false dichotomy that addiction is a “brain disease” and not a “moral failing” while portraying themselves as altruistic advocates of the afflicted, this subgroup of the ASAM has cultivated an organization that exudes authority, knowledge, respectability, and advocacy.  But they are an illegitimate authority and others must be made cognizant of this fact.

The ASAM has set forth definitions of addiction, shaped diagnostic criteria, dictated assessment protocols and shaped public policy all under the guise of scholarship and compassion. But is this the real motive?  I don’t think so.

This same group introduced junk science such as the EtG and PEth alcohol biomarkers through Greg Skipper, FSPHP, ASAM, and a like-Minded Doc who can also be found on this list.  The conflicts-of-interest are serious and vast.

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This same group has created the “impaired” physician construct as well as the  “moral panic” of a hidden cadre of drug addled and besotted doctors protected by a “culture of silence” that has seriously damaged the reputation of doctors and the medical profession through the eyes of both regulators and the general public.

This same group has introduced and promulgated the nebulous “disruptive physician” and successfully fostered a moral crusade to attack this huge apparently hidden but non-existent threat.

The next target is the “aging physician” and if you do an internet search you will see they are currently fomenting a call to arms to root out senility in medicine.

This same group used the same tactics in each case.

With no evidence base they used propaganda and disinformation to convince regulatory and administrative medicine that witches are real, witches are dangerous, and that they were the experts when it came to identifying, assessing and treating witches.    And it worked.
By infiltrating state PHPs they have become the might and main of addiction medicine in the United States.

By removing dissenters who disagreed with the groupthink they have taken over almost all  of the state PHPs organized under the Federation of State Physician Health Programs (FSPHP).

And this is where it becomes interesting.

Screen Shot 2014-05-07 at 5.38.23 PMState PHPs are very strict when it comes to choice in rehabilitation facilities for for physicians in need of assessment and treatment for substance abuse.

In fact there is no choice in the matter.
As home to some of the countries top ranked hospitals and most prestigious medical schools Massachusetts is an international healthcare hub with world-class teaching, research, and clinical care.

Two of the top three psychiatric hospitals in the United States as rated by U.S. News and World Report are found here in Massachusetts with McLean Hospital earning the top prize and Massachusetts General Hospital ranked number three.

However, this medical mecca of learning and research is apparently unable to attract anyone with competence and skill to assess physicians for substance abuse or disruptive behavior.
In Massachusetts if the State PHP, PHS,inc. feels a physician is in need of an assessment the evaluation must be done at “a facility experienced in the assessment and treatment of health care professionals” It must be done at a “PHP-approved” facility. No exceptions.

And apparently these esoteric skills are only found in Georgia, Arkansas, Alabama, and a half dozen other places.Screen Shot 2013-11-25 at 4.55.18 PM
With over 20 years experience with the Massachusetts PHP, Physicians Health Services, inc., Harvard Medical Schools Dr.’s John Knight and J. Wesley Boyd wrote an article in the Journal of Addiction Medicine last year concerning ethical issues in state PHPs.

Ethical and Managerial Considerations Regarding State Physician Health Programs

IMG_9115 One of the issues Knight and Boyd discussed was the conflicts of interest between the state PHPs and the evaluation centers.

One comment I was surprised got past editorial review was that the treatment centers may “consciously or otherwise” tailor diagnosis and recommendations to the PHP’s impression of that physician. “Consciously” tailoring a diagnosis is fraud. It is political abuse of psychiatry.

If you look up the medical directors of the “preferred facilities” and then cross reference with the list of LMD’s you get a perfect match.
So when the PHP refers a physician for an evaluation and gives them a choice of an assessment facility there is no choice.

It is three card monte. It is a shell game. Heads I win tails you lose.
The ASAM has imposed the prohibitionist chronic brain disease spiritual recovery model of addiction on the field of medicine.

It is a system of coercion, control, and indoctrination. And another ASAM Like-Minded Doc, Robert Dupont, is calling this the “new paradigm” of addiction medicine and wants to spread it out to other venues including schools.
Like-Minded Docs solves the final piece of the puzzle. It explains why so many doctors across the country are claiming fabrication and manipulation of personality and cognitive tests to support nonexistent diagnoses.

They are not gathering data to form a hypothesis but making data fit a hypothesis that arrived before they did.

It also explains the marked increase in physician suicide.

With guilt assumed from the start, no due process, no appeal and no way out physicians are being bullied, demoralized, and dehumanized by these zealots to the point of hopelessness.

This needs to stop.

Medicine is predicated on competence, good-faith, and integrity. Medical ethics necessitates beneficence, respect, and autonomy. The scaffold erected here is designed for coercion and control. Exposure, transparency, and accountability are urgent. An evidence based Cochrane type assessment of their “research” and an Institute of Medicine Conflict of Interest review are long overdue.

The emperor has no clothes and sunshine is the best disinfectant.

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Disrupted Physician 101.5: The American Society of Addiction Medicine (ASAM) uses (or misuses) Alcoholics Anonymous (AA)

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 The goal of the ASAM has always been to get the medical establishment to accept 12-step spiritual recovery.

AMSA evolved into the ASAM

AMSA evolved into the ASAM

According to the American Society of Addiction Medicine The ASAM Principles of Addiction Medicine is the “go-to textbook in the specialty of addiction medicine” and:

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The 4th Edition of The ASAM Principles of Addiction Medicine contains an entire section entitled “Mutual Help, Twelve Step, and Other Recovery Programs” containing three chapters entitled “Twelve Step Programs in Recovery,”1 “Recent Research into Twelve Step Programs”2 and “Spirituality in the Recovery Process.”3

Despite the all-encompassing title of this 31-page section (pages 911-942) no “other recovery programs” are described. In fact, no other programs bar 12-step ideology are even mentioned.

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I have read through each chapter word-for-word three times just to be sure; and although the chronic relapsing brain disease model of addiction requiring lifelong abstinence and spiritual recovery is described, trumpeted and proselytized in great detail, not one other model of addiction is even named.

As with anything I write I encourage you to fact-check this. My goal here is to present my opinions with facts and evidence that can be checked and verified. Point out any errors of fact and I will promptly remove and correct them. 

If a Cardiology textbook had a section entitled “Cholesterol, Statins and other Lipid Lowering Agents” with three chapters that only described Lipitor it would be correctly lambasted from every angle by the entire field of medicine as soon as it hit the shelves.

The lack of evidence-base and conflicts-of-interest would be recognized and dealt with immediately and when it was realized that many of the authors not only profited from, but  based their very own cardiac health on Lipitor they would rightly be held accountable. Such is not the case in Addiction Medicine.

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 appeal to Authority is a fallacy with the following form:

  1. Person A is (claimed to be) an authority on subject S.
  2. Person A makes claim C about subject S.
  3. Therefore, C is true

The fallacy is committed when the person (or group) in question is not a legitimate authority on the subject. If person A is not qualified to make reliable claims about subject S then the argument will be fallacious.   Since this sort of reasoning is fallacious only when the person is not a legitimate authority it is necessary that acceptable standards be set and the following standards are widely accepted.

  1. The person has sufficient expertise in the subject matter in question.
  1. The claim being made by the person is within her area(s) of expertise.
  1. There is an adequate degree of agreement among the other experts in the subject in question.
  1. The person in question is not significantly biased.
  1. The area of expertise is a legitimate area or discipline

With the exception of number 5 the ASAM fails on all counts, but policy makers, members of the press, politicians and others have been successfully bamboozled into believing the ASAM are indeed “experts” in Addiction Medicine.   imgresOver the years, the American Society of Addiction Medicine has continued to promote the AA position that alcoholism (and by inference any other addiction) is an illness which only a “spiritual experience will conquer.” All addictions are believed by ASAM to be caused by a lifelong chronic relapsing brain disorder that can only be treated by complete abstinence from all mood-altering substances (with the apparent exceptions of tobacco and caffeine interestingly) and the vast majority of ASAM doctors believe that the only effective treatment for addiction must include surrendering one’s “will and life over to the care of God.”

Because addiction is defined as a disease, addicts must be “treated” (often coerced) and “cured” (which is defined as remaining abstinent).

The medical profession needs to reexamine its role in Addiction Medicine.

Confusing ideological opinions with professional knowledge is unacceptable.   Presenting it as textbook science is not only dangerous but fosters negligence, abuse of power, self-interest and prejudice on the part of the medical community with respect to the treatment of all patients.

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To be clear, just as Lipitor may be the best treatment for some individuals with elevated cholesterol, AA and 12-step may be the best treatment for some individuals with addiction and substance use disorders. If it works for them, then more power to them. I have no problem with that.

What I do have a problem with is imposing and mandating any treatment on others.

Under a dictatorship everything else becomes subordinated to the guiding philosophy of the dictatorship.   Corresponding doctrine replaces professional guidelines, standards of care, and evidence based medicine.  And unfortunately in the case of Addiction Medicine the guiding philosophy often trumps autonomy and ethics.

Inherent in the current chronic brain disease model of addiction is the importance of external control over individuals.  Political correctness and the oversimplified medicalization of addiction is allowing it.   Demanding scientific literacy and discriminating good science from bad science would prohibit what is occurring and In order to save American Medicine this problem needs to be clearly recognized. Otherwise we will become a profession that is essentially defined by the false dichotomies and grand illusions defined by the impaired physicians movement.

  1. Schulz JE, Williams V. Twelve Step Programs in Recovery. In: Ries R, Fiellin D, Miller S, Saitz R, eds. Principles of Addiction Medicine. Baltimore: Lippincott Williams & Wilkens; 2009:911-922.
  2. McCrady BS, Tonigan GS. Recent Research into Twelve Step Programs. In: Ries R, Fiellin D, Miller S, Saitz R, eds. Principles of Addiction Medicine. 4 ed: Lippincott Williams & Wilkens; 2009:923-937.
  3. Galanter M. Spirituality in the Recovery Process. In: Ries R, Fiellin D, Miller S, Saitz R, eds. Principles of Addiction Medicine. 4 ed. Baltimore: Lippincott Williams & Wilkens; 2009:939-942.
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The High PROFITS of the 12 Step Cult Religion and Bain Capital

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

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

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

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

From the 15th century through the early 17th century a confederacy of “authorities” calling themselves “demonologists” existed and made money off the misery of others.

Identification of witches was detailed in the Malleus including both physical and behavioral clues. Physical signs included things such as bushy eyebrows and thin lips. The Malleus declared that witches have a “Devil’s mark (stigmata diaboli) or Devils seal (sigilum diaboli) which was usually a scar, birthmark, or blemish. An extra nipple (polythelia) was a tell-tale sign. Behavioral manifestations included living alone, cultivating strange herbs in the garden, public singing or dancing and saying hello to a neighbors cat.

Physician oversight of witch persecution was standard.  So too was the involvement of “witch-prickers” who were able to provide their expertise and “medical” testing in the assessment and diagnosis of the witch.

Pricking them with needles, awes, and bodkins to prove they were indeed nefarious and non-human was a surefire way to line one’s pockets but for the pedophiles and pervs there was an added bonus—a thorough searching for that stigmata diaboli on someone else’s dime.

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

Even the people who made the stakes and scaffolds for executions gained from the conviction and death of each witch.

“Witch hunting,” wrote the historian Rossell Hope Robbins, “was self-sustaining and became a major trade, employing many people, all battening on the savings of the victims.” The costs of a witch trial were usually paid for by the estate of the accused or their family.

And what my friend Laura Tompkin’s describes here in no different; except in place of “demonologists” we now have “addictionologists.”

Both faulty paradigms with a lot of people making money hand over fist.

In 1592 Father Cornelius Loos wrote:

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

And this is no different. No different at all.

12 Step Cult Religion Exposed

The following article will educate you on the annual profits made by the 12 step industry.  Whenever steppers claim that their cult is free, you now have proof that it is most certainly not in any way, shape or form, free.  Just because people are too lazy, ignorant and/or brainwashed, is no excuse for perpetuating dangerous lies.  Please note that anything in parentheses is my addition and anything bolded is also mine.  This author is misinformed, as is the general public, and classifies alcohol disorders as diseases.  However, this misinformation does not disqualify the facts here about rehab profits and Bain Capital.

Bain Capital’s grip on addiction – The profit of 12-step treatment

By Jamie Wendland

Last year nearly 2.5 million people 12 years of age or older sought treatment for substance abuse in the U.S., according to the National Survey on Drugs and Health. 2.3 million Americans…

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