Medical Students at Risk as Fraudulent Physician Health Programs (PHPs) Cast a Wider Net–Need to Address This Problem at State Level

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Physician Health Programs (PHPs) now targeting medical students–More sheep for the slaughter

The attached article entitled “Medical school drug testing is a moral and scientific failure” opposes testing medical students for drugs and alcohol but things are going to get a whole lot worse.

In the past six-months I have been contacted by an increasing number of  medical students searching for help after being  trapped in quagmire of their state physician health program  (PHP).   Each of them had either been referred to a “PHP-approved” assessment center or had already had an evaluation recommending inpatient treatment.

Some of these students were subjected to non-FDA approved laboratory developed tests including hair testing for marijuana metabolites and the  alcohol  biomarker EtG.  These typeof tests can detect substances that were used days, weeks and even months prior to testing.

Medical students and physicians are just as likely to have experimented with illicit substances in their lifetimes as their age and gender matched peers.1

Although medical students as a group drink slightly more alcohol than the general population, the pattern and prevalence of alcohol, dependence is consistent with their age mates in the general population.1 2

Like it or not recreational and experimental drug use is widespread in young adults and most of them “grow out of it” and the 21st Amendment repealed the Volstead Act in 1933.  Alcohol is legal and those that can handle it have a right to a round of beers after a long day or imbibe a cocktail with a dinner date.  But according to the prohibitionist profiteers and moral preeners any drug or alcohol use is a sign of “potentially impairing illness” that must be addressed and treated early to prevent an inexorable slide into a chronic relapsing brain disease and abstinence and lifelong adherence to the principles 12-step spirituality are the only way to do so.

An old joke asks “How does a doctor define an alcoholic?”  Answer–“anybody who drinks more than he does.”   How does a PHP define an alcoholic?  Answer –anybody who walks through the front door.

In reality, a zero-tolerance paradigm utilizing this type of testing would be ruinous. With recreational and experimental drug use common in young adults a profession that refuses to accept anyone who tests positive for drugs will exclude large numbers of brilliant, talented individuals. Dismissing highly talented people in medicine for what might be a one-off recreational non problematic drug experience would retard its advance.

The use of these non-FDA approved tests of unknown validity should not be allowed to begin with but there needs to be a concerted direct attack on their use on medical students or the brain-drain on the profession will bring it back to the dark ages.  The ASAM White Paper on Drug Testing proposes imposing this system with mandatory drug testing by the healthcare system from childhood to old age.  College loans are proposed as “leverage” for college students in this “contingency management” paradigm so a lot of promising students could be weeded out before even applying to medical school.  Forget GPA and MCATS as the primary criteria for medical school admission will be sobriety and clean urine screens..

Diagnosing disease without meeting the diagnostic criteria for that disease.

None of the students who contacted me seemed to fit the diagnostic criteria for the diagnosis given to them stories which were articulate, detailed and sincere.   All cases involved either a naive mistake or isolated incident.

One student made the disastrous revelation to a PHP director who had just given a class lecture that she had smoked marijuana with her high school friends in her home state of Colorado.   She was then called in by the PHP and referred for an evaluation at an out of state facility where she was diagnosed with “marijuana dependence” based on a positive low level THC metabolite on a hair follicle test.  She was told she was in denial and inpatient treatment was recommended.  Although she admitted to occasional weekend marijuana use there were absolutely no problems in any realm of her life. It is self-evident that impairment due to drugs or alcohol impacting someones capacity to work or function needs to be addressed but the penalty imposed on her for her private behavior was to end her career in medicine before it even started.  The medical school administration mandated she either complete the treatment required by the PHP or she would not be able to enroll the following semester and not being able to come up with the up-front out-of-pocket cost for treatment she was not able to return to the medical school and has decided to pursue a different career.

Another student was anonymously reported to the PHP for smoking marijuana at a weekend party which resulted in a similar assessment and recommendation for inpatient treatment.  After spending 3 months at a facility in Alabama he is now under monitoring contract with his PHP but returned to school.

Healthy student asks for help in his organizational skills–ends up with a psychiatric and substance abuse diagnosis

After reading an advertisement in the state medical society newsletter promoting work-life balance a second-year medical student contacted his state PHP to obtain advice on his problem with “procrastination.”    Classes and working part time in the endocrinology lab left him with little time and he found himself slacking off on his exercise routine and burning the midnight oil before test nights.  He told the PHP director about his history of depression after his father died immediately before his freshman year at college. That October he became overwhelmed with sadness and missed his dad and hometown.  He sought help from the campus physician who prescribed prozac which was discontinued in a years time without return of any symptoms.

Realizing there were no classes in work-life balance but only a support group for “burnout” the student declined the PHP directors offer of an assessment of his “mental health.”  Much to his surprise he was called in the following week by a medical school administrator and told that the PHP was requiring an assessment at one of two out of state “PHP-approved” assessment centers in Lawrence Kansas.  He was at first confused at the nonsense he was hearing and then became indignant  at the nonsensical and illogical request without rhyme or reason and the betrayal of trust and ethics.  “Surely this must be a HIPPA violation.”   He obtained an outside consultation from a psychiatrist and contacted the campus physician who confirmed his diagnosis was acute situational depression and bereavement but the PHP disregarded the information.  He bartered for a local evaluation but this was refused.  He arranged for the 96-hour assessment in  Kansas.  His mother paid the requisite out-of-pocket up-front $4,500.00 to the facility and  she told him not to worry as his life would get back to normal after they confirmed he had no psychological problems.  “Dysthymia, Major depressive disorder, severe, in remission and alcohol use disorder” were given as diagnoses.  “Alcohol use disorder” was based on a hair test for EtG which was the result of his drinking an occasional beer or two with friends after school and on the weekends.  He was told  he may be “self-medicating” and playing “Russian roulette” given his history of depression.  Recommendations included inpatient treatment followed by a “structured aftercare program” of abstinence and monitoring by for alcohol and drugs of abuse.  Forced to sign a contract with the PHP he was understandably upset at the serious and unfounded sequelae that was the result of asking for help.

Another fourth-year student got into a bit of a shoving match with his buddy at the bar on a Saturday night and was reported  to his PHP anonymously.  He is awaiting evaluation.

This brings up another potential problem–sham peer review. As PHPs accept anonymous referrals what is in place to prevent inappropriate referrals based on removing a competitor and improving your academic standing.

A legitimately prescribed stimulant for ADHD bought a third year student into a PHP contract. He was  forced to discontinue the medication prescribed by a psychiatrist specializing in childhood ADHD by a family practitioner in “recovery” from abusing intravenous fentanyl who had been monitored by the PHP himself for ten years then became medical director after getting board certified as an addiction medicine specialist.

This student got 99th percentile across the Board on his MCATs and may one day cure cancer but now faces an uncertain future as he recently got a positive EtG on a urine test and they are currently “sorting this out.”

The most bizarre story was from a student who sought help for sleep troubles after reading about the PHP as a referral source. He subsequently saw a sleep-specialist and was diagnosed with an oversized uvula which was surgically corrected.  His sleep troubles improved but his troubles with the PHP remained.  A triathlete and excellent student the PHP determined he had a “thought disorder” and discussions of “schizophrenia” were entertained by the PHP and they recommended an out of state evaluation at one of the three gulags used by the FSPHP for  “disruptive physician”  and behavioral exams–Vanderbilt, Acumen and the Professional Renewal Center.  All of these facilities come with a guaranteed diagnosis.   Polygraphs and unvalidated neuropsychological instruments designed to detect “character defects”  cast a pretty wide net.

Question FSPHP with direct questions to undermine a “culture of professionalism.

It is important that medical school administrators refuse to engage in  blind deference to the authority of the state PHP.  Authority must always be questioned and to not do so is irresponsible.  Unquestioning allegiance to an authority does not comport with the history of the medical profession or science.  Faith in institutions demands mass adherence to faith in that authority and direct challenges to the status quo are needed to undermine that faith.   They have bamboozled the medical boards into implementing bad policy, approving bad science and making bad decisions.  They have duped state legal authorities into deference to their expertise and integrity under the notion that questioning these attributes undermines a culture of professionalism.  Fact of the matter is they have no expertise, no integrity and no professionalism.

PHPs have been contaminated with an outside influence and support an agenda that has nothing to do with protecting the public or helping medical students.  They are an illegitimate authority that has become an irrational authority and their recommendations mandate direct answers and justification.

If the PHP has concerns about a student then the first step should be to obtain an independent second opinion.  PHPs discourage second these second opinions and disregard all outside expert opinion no matter how well qualified and experienced that expert is.  Anyone outside this brood of addiction addicts is scoffed at as biased or unenlightened to the simplistic belief system with which they have contaminated the medical profession.     Look into the assessment centers to which they are mandating referral.  Ask what qualitative factors and quantitative measurements were used to approve that facility and why no one in Massachusetts has the ability come to a competent diagnosis.   The yarn that doctors and medical student have an ability to dissemble and appear normal while harboring a “potentially impairing condition” is one of the medical urban legends they started.  Ask to see the evidence base.  There is none and it defies common sense, logic and science.

An increasingly bright light is being shed towards the malfunctions and corrupt practices of this unaccountable confederacy of “authorities” and at some point soon their jig will inevitably be up.     In the interim, if you are referred to a PHP it would be a good idea obtain independent lab tests and two second opinions.  Although the PHP will disregard this documentation it would be wise to obtain it to prove both your normality and the discrepancy between your independent evaluation results and the cherry-picked pulled out of a hat multiple diagnoses confabulated and misrepresented by the PHP.

  1. Hughes PH, Brandenburg N, Baldwin DC, Jr., et al. Prevalence of substance use among US physicians. JAMA : the journal of the American Medical Association. May 6 1992;267(17):2333-2339.
  2. Flaherty JA, Richman JA. Substance use and addiction among medical students, residents, and physicians. The Psychiatric clinics of North America. Mar 1993;16(1):189-197.

 

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Medical school drug testing is a moral and scientific failure
ANONYMOUS | EDUCATION | MAY 11, 2014

Before the 1980s, drug testing was uncommon. It was widely viewed as an invasion of privacy and an infringement on fourth amendment rights. Today, a medical student is likely to be drug tested before entering medical school, before clinical rotations, and/or before residency. If preventing drug use among medical students is the goal of these tests, they have failed miserably. Urinalysis drug tests are ineffective. But more importantly, they are immoral.

Drug tests are ineffective for two reasons. First, they basically just test for marijuana. A 10 panel urinalysis technically tests for 10 different drugs, but marijuana is one of the only drugs that can be detected for more than 30 days. Cocaine can be detected for 4 days. Amphetamine, methamphetamine, ecstasy, heroin, and codeine all can be detected in urine for only 2 days. This means that a user of drugs far more dangerous than marijuana needs to abstain for just a couple of days. Psilocybin mushrooms, as well as several other mind-altering drugs, are not tested for at all.

For a marijuana user, a drug test might seem like a nightmare. But here we arrive at the second reason why drug tests are ineffective, they are easily beaten. A marijuana user may choose to drink a lot of water before his drug test to dilute his urine. Alternatively, he may choose to use a friend’s urine who he knows does not use marijuana. Either one of these options might work. But fortunately for such a marijuana user, there is another option that is essentially risk free, synthetic urine. There are several companies that make synthetic urine capable of beating drug tests. The word on the Internet is that Quick Fix is a safe bet. I personally know some people who would agree. At just $30 for a bottle, it looks like the drug test is no match for the free market.

Do not just take my word for it though. In 2003, the University of Michigan conducted a study on the effectiveness of drug testing students. From nearly 900 schools, the study found that drug testing, whether routine, random, or based on suspicion, had no measurable effect on drug use among students. Put simply, drug testing accomplishes nothing.

The most important concern I have about drug testing medical students is a moral one. Regardless of their effectiveness, or ineffectiveness, the endgame of drug testing is to prevent drug users from becoming doctors. Users, not addicts; and there is a big difference. A marijuana user might use on weekends or at night to relax, much like an alcohol user. A marijuana addict, although rare, is the type of person who might show up to important occasions intoxicated. The statistics on marijuana addiction vary. They usually show that less than 10% of users become addicts, but they always show that alcohol users have higher rates of addiction. A urinalysis detects alcohol for no more than 12 hours after use. This means that medical students who use alcohol are more likely to be addicted, and they face basically no risk of failing a drug test.

Should we be worried about medical students being drunk in clinical settings? Of course. And we should also be worried about medical students being high in clinical settings. Intoxication could be disastrous and it needs to be prevented. The good news is that this is done naturally. It is highly unlikely to find medical students who are addicts of marijuana, alcohol, or any mind-altering drug. I believe it is safe to say that the rigor of medical school itself prevents drug addicts from becoming doctors. There are, however, drug users who will make it into medical school or other rigorous scientific careers. Actually, many of them thrive. Richard Feynman, Kary Mullis, and Francis Crick used marijuana and LSD, Carl Sagan used marijuana, and Oliver Sacks used several illicit drugs. When drug tests are required for every medical student, the casual drug user, no matter how much potential he has, is bullied for no reason. The potentially dangerous drug addict has already been weeded out long ago.

Medical school is supposed to be based on science. The science shows that drug testing does not work. If it did work, then many great scientists would have been removed from their professions. These facts alone should be enough to settle the issue, but it is important to look at two more moral objections we should all have.

First, drug tests are not free. Before entering medical school, I paid about $30 for one. This does not sound like much. But charging students even one penny is unacceptable, for there is not even a fraction of a penny in benefit from these tests. The nearest drug testing facility for me was a 20 minute drive from my house. I could have driven anywhere for 20 minutes and just handed $30 to any random person. Surely, that $30 would bring more value to society than $30 wasted on a drug test. Imagine if a police officer searched a person’s car for drugs against his will, found none, and then charged this person $30. That is the reality of drug testing.

Second, drug tests are an invasion of privacy. Medical students should not be forced to prove their innocence. This creates a guilty until proven innocent environment. It immediately creates resentment among students, and rightfully so. Furthermore, what about people with paruresis? The International Paruresis Association estimates that 7% of people suffer from this condition, also known as shy bladder. Type “paruresis drug test” into a search engine and spend some time reading through the horror stories that are shared. These people suffer from a medical condition, and of all places, their medical school is completely inconsiderate.

Drug testing is a moral and scientific failure. Medical schools should be too embarrassed to take part in such nonsense.

The author is an anonymous medical student who blogs at unchainedmedical.
TAGGED AS: MEDICAL SCHOOL

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The Federation of State Physician Health Programs (FSPHP) is an unexamined, illegitimate and irrational authority: Let’s drain this swamp in 2017!

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Nosce te ipsum. Nosce inimicum tuum

According to Erich Fromm rational authority is based on competence, experience, and mutual respect.  Irrational authority is often disguised as benevolent paternalism and is designed to perpetuate or intensify conditions of inequality through the use or threat of force, deceptiveness, and secretiveness.

The Federation of State Physician Health Programs (FSPHP) has has operated as an unexamined authority for the past 25-years .  They have pushed practice and policy unquestioned and without opposition that has gravely harmed individual doctors, the medical profession itself and the public at large.  Everything they have done has been done to benefit themselves and their drug and alcohol assessment, testing and treatment affiliates in the provision of protections, power and profits.

screen-shot-2017-01-30-at-11-59-14-pmExamining the specific practice and policy pushed reveals a body of false-claims making designed to facilitate the systemic use of coercion and threats, remove all due process protections and fundamental rights from physicians and prevent, block and eliminate the evidence.  This practice and policy collective has created a culture of impunity, immunity and deference that is able to successfully conceal ethical violations and crimes.  Uncovering their wrongdoing is a nearly impenetrable gauntlet. It is a system of institutional injustice that is undoubtedly a major contributor to the suicide epidemic in the profession.  They have been able to conceal the truth, avoid investigation and prevent punishment for years by removing themselves from all accountability and outside inquiry. Direct and specific questioning appears to be their Achille’s heel as the recent spat of articles critical of these programs is showing just how much of an illegitimate authority they really are.screen-shot-2017-01-30-at-11-59-05-pm

In her rebuttal to Pauline Anderson’s article “Physician Health Programs: More Harm Than Good?” FSPHP President Doris Gunderson dismissed the accusations of fraud and abuse in one fell swoop as  “allegations rather than facts” and second hand anecdotes.  Countering allegations of an absence of oversight and regulation she states:

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“In fact, we operate under a microscope, answering to individual practitioners, medical boards, malpractice carriers, defense attorneys, state attorneys, medical societies, hospitals, medical schools and residency training programs. We are also accountable to patient safety entities and a Board of Directors.”

Untrue. Accountability demands both provision of information and justification for actions to outside entities capable of punishing misconduct. . What was done and why?  No such entity exists and no pathway for appeal or grievance redressal exists either. Zero accountability.  Ditto for the “PHP-approved” assessment and treatment centers. As cash only out-of-pocket facility they remove themselves from the prying eyes of insurers.

screen-shot-2016-01-13-at-9-55-47-amThe North Carolina PHP Audit  found the past FSPHP President and NC PHP director Warren Pendergast could not identify the qualitative or quantitative indicators used for “approving”  PHP-approved facilities. The best he could come up with is “reputation” and “word of mouth” yet state medical boards mandate evaluations of doctors at these  facilities and specifically exclude  non-“PHP-approved” facilities.This is enforced by the Federation of State Medical Boards Policy on Physician Impairment.  Each state managed by the FSPHP utilizes the same dozen or so facilities and each state medical board mandates it under threat of disciplinary action.  It is in fact a rigged game.

Denying accusations of coercion Gunderson states in her rebuttal to Anderson’s article:

“The detractors of PHPs interviewed for the article maintain that PHPs are coercive. Yet the report fails to mention that PHPs have no authority to mandate treatment and monitoring, suspend or revoke licensure, or otherwise discipline physicians.”

screen-shot-2015-10-07-at-7-11-18-pmThe report fails to mention it because it is more either/or logical fallacy based on the false dichotomy between “treatment” and “punishment” that is often used to promote the FSPHP mythology.  Although PHPs do not have the legal authority to mandate, suspend or revoke a license they have the functional authority to do so.   This is also dictated by public policy.  (ASAM Policy on Coordination Between Treatment Providers,  Professionals Health Programs, and Regulatory Agencies).

Legitimate authority articulates ethical, evidence-based, or internally consistent arguments when challenged.  Legitimate authority does not simply delegitimize one’s opponent and use logical fallacy and obfuscation to avoid addressing the substance of an argument. In her rebuttal Gunderson claims the NC Audit was favorable to them because no evidence of abuse was found.  This is akin to a serial killer claiming victory because no bodies were found in his dungeon replete with torture devices and restraints. State auditor Beth Wood set this straight when she told the BMJ in  Physician Health Programs Under Fire  that the holes were big enough in the program “you could drive a truck through them” and it would be “difficult, if not impossible, to defend” oneself against an incorrect assessment” as no ability to “appeal a diagnosis or assessment” existed.

screen-shot-2016-01-13-at-9-52-11-am“Compounding the problem, said Wood, was that “the chief executive and medical director were in total control of entire process.” They assessed allegedly impaired doctors, but when those assessments were contested, they were responsible for presenting complaints to the state medical board. The doctors concerned were not allowed to be present and were not allowed to see the programs’ medical reports on them.”

Multiple Barriers Removing Accountability at Multiple Levels

The  inability to obtain one’s own medical records or lab reports is the first obstacle one must overcome. The second barrier is that even if documents are obtained there is no one to give them to.  The third is the existence of “point people” who deflect, block and otherwise dismiss valid complaints.  The only oversight provided to the involved labs is an an accreditation agency, the  College of American Pathologists (CAP) They can investigate and correct but do not have the ability to sanction.

screen-shot-2016-12-09-at-1-13-29-pmOf the many hundreds of doctors I have spoken to and who have taken my survey not one has been able to obtain evidence of abuse.  It was either refused, censored or doctored.   I have obtained documentary evidence that is specific, detailed and unequivocal.

It is therefore critical it be recognized for what it shows and it is morally imperative that those involved be held to account as the documents illustrate clearly and undeniably a collusion between a state PHP and its drug testing lab to fabricate evidence.  The corruption is top-down as it involves another former FSPHP President Luis Sanchez and the VP of Laboratory operations at USDTL Joseph Jones.  As explicit and detailed as it is in revealing unequivocal  black and white crimes it has been ignored by the usual channels.

Screen Shot 2017-01-30 at 11.58.54 PM.pngResearch on street criminals suggests the certainty of punishment has the strongest deterrent effect (basically will I be caught) and the more people think they will be arrested for a crime the less likely they are to commit it. Criminals weigh their actions against possible gains and consequences and the risk of consequences in this system have been essentially zero.  Diagnosis rigging, coercion, threats and abuse are rampant because they have no fear of punishment.  The Chairman of the commission that examined the  causes of the 2008 financial collapse compared the  relatively small fines paid by corporations to “someone who robs a 7-Eleven, takes $1,000 and being able to settle for $25 and no admission of wrongdoing.” He added,“Will they do it again? Absolutely, because it pays.” This is like someone who robs a 7-Eleven, takes $1,000 and never gets caught so he goes to the next 7-Eleven and takes $2000 then hits as many 7-Elevens as he can for as much as he can. There is zero-accountability. No fines. No repercussions. No risk. What has happened is not only logical but inevitable. It is time to name the enemy.  The enemy is not state physician health programs (PHPs) but those in charge of them. The Federation of State Physician Health Programs (FSPHP) is a heretofore unexamined authority.    Current evidence is revealing the FSPHP is also an irrational authority. It is also quite easy to show by historical documentation of the policy and practice they have pushed that they are an illegitimate authority.   Illegitimate authority when identified and recognized needs to be removed.

Nosce te ipsum. Nosce inimicum tuum. Know thyself, know thy enemy.  The FSPHP is the enemy. They cannot be bargained with. They need to be removed.   In the interim we need to set up advocacy and watchdog groups to help and protect those already caught in this web of manipulation, oppression and fear. Wake up, Stand up and Speak up.  Silence is consent. Let’s drain this swamp in 2017.

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Please donate!  Need urgent funding!  No donation is too small. Come on! https://www.gofundme.com/PHPReform

 

 

I am Offering Over $25,000 in cool prizes to anyone who can prove fewer than 3 felonies were committed by past FSPHP President Sanchez as shown by documentary evidence alone! I claim I can detect multiple very serious crimes in these documents–prove me wrong and the whole lot is yours!

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Federation of State Physician Health Programs (FSPHP) removed from accountability with low risk of suffering consequences for misconduct

According to Erich Fromm rational authority is based on competence, experience, and mutual respect.  Irrational authority is often disguised as benevolent paternalism and is designed to perpetuate or intensify conditions of inequality through the use or threat of force, deceptiveness, and secretiveness.

The Federation of State Physician Health Programs (FSPHP) has has operated as an unexamined authority for the past 25-years .  They have pushed practice and policy unquestioned and without opposition that has gravely harmed individual doctors, the medical profession itself and the public at large.  Everything they have done has been done to benefit themselves and their drug and alcohol assessment, testing and treatment affiliates in the provision of protections, power and profits.

Examining the specific practice and policy pushed reveals a body of false-claims making designed to facilitate the systemic use of coercion and threats, remove all due process protections and fundamental rights from physicians and prevent, block and eliminate the evidence.  This practice and policy collective has created a culture of impunity, immunity and deference that is able to successfully conceal ethical violations and crimes.  Uncovering their wrongdoing is a nearly impenetrable gauntlet. It is a system of institutional injustice that is undoubtedly a major contributor to the suicide epidemic in the profession.  They have been able to conceal the truth, avoid investigation and prevent punishment for years by removing themselves from all accountability and outside inquiry. Direct and specific questioning appears to be their Achille’s heel as the recent spat of articles critical of these programs is showing just how much of an illegitimate authority they really are.

In her rebuttal to Pauline Anderson’s article “Physician Health Programs: More Harm Than Good?” FSPHP President Doris Gunderson dismissed the accusations of fraud and abuse in one fell swoop as  “allegations rather than facts” and second hand anecdotes.  Countering allegations of an absence of oversight and regulation she states:

screen-shot-2016-01-13-at-9-56-37-am

“In fact, we operate under a microscope, answering to individual practitioners, medical boards, malpractice carriers, defense attorneys, state attorneys, medical societies, hospitals, medical schools and residency training programs. We are also accountable to patient safety entities and a Board of Directors.”

Untrue. Accountability demands both provision of information and justification for actions to outside entities capable of punishing misconduct. . What was done and why?  No such entity exists and no pathway for appeal or grievance redressal exists either. Zero accountability.  Ditto for the “PHP-approved” assessment and treatment centers. As cash only out-of-pocket facility they remove themselves from the prying eyes of insurers.

screen-shot-2016-01-13-at-9-55-47-amThe North Carolina PHP Audit  found the past FSPHP President and NC PHP director Warren Pendergast could not identify the qualitative or quantitative indicators used for “approving”  PHP-approved facilities. The best he could come up with is “reputation” and “word of mouth” yet state medical boards mandate evaluations of doctors at these  facilities and specifically exclude  non-“PHP-approved” facilities.This is enforced by the Federation of State Medical Boards Policy on Physician Impairment.  Each state managed by the FSPHP utilizes the same dozen or so facilities and each state medical board mandates it under threat of disciplinary action.  It is in fact a rigged gam

Denying accusations of coercion Gunderson states in her rebuttal to Anderson’s article:

“The detractors of PHPs interviewed for the article maintain that PHPs are coercive. Yet the report fails to mention that PHPs have no authority to mandate treatment and monitoring, suspend or revoke licensure, or otherwise discipline physicians.”

screen-shot-2015-10-07-at-7-11-18-pmThe report fails to mention it because it is more either/or logical fallacy based on the false dichotomy between “treatment” and “punishment” that is often used to promote the FSPHP mythology.  Although PHPs do not have the legal authority to mandate, suspend or revoke a license they have the functional authority to do so.   This is also dictated by public policy.  (ASAM Policy on Coordination Between Treatment Providers,  Professionals Health Programs, and Regulatory Agencies).

Legitimate authority articulates ethical, evidence-based, or internally consistent arguments when challenged.  Legitimate authority does not simply delegitimize one’s opponent and use logical fallacy and obfuscation to avoid addressing the substance of an argument. In her rebuttal Gunderson claims the NC Audit was favorable to them because no evidence of abuse was found.  This is akin to a serial killer claiming victory because no bodies were found in his dungeon replete with torture devices and restraints. State auditor Beth Woods set this straight when she told the BMJ in  Physician Health Programs Under Fire  that the holes were big enough in the program “you could drive a truck through them” and it would be “difficult, if not impossible, to defend” oneself against an incorrect assessment” as no ability to “appeal a diagnosis or assessment” existed.

screen-shot-2016-01-13-at-9-52-11-am“Compounding the problem, said Wood, was that “the chief executive and medical director were in total control of entire process.” They assessed allegedly impaired doctors, but when those assessments were contested, they were responsible for presenting complaints to the state medical board. The doctors concerned were not allowed to be present and were not allowed to see the programs’ medical reports on them.”

Multiple Barriers Removing Accountability at Multiple Levels

The  inability to obtain one’s own medical records or lab reports is the first obstacle one must overcome. The second barrier is that even if documents are obtained there is no one to give them to.  The third is the existence of “point people” who deflect, block and otherwise dismiss valid complaints.  The only oversight provided to the involved labs is an an accreditation agency, the  College of American Pathologists (CAP) They can investigate and correct but do not have the ability to sanction.

screen-shot-2016-12-09-at-1-13-29-pmOf the many hundreds of doctors I have spoken to and who have taken my survey not one has been able to obtain evidence of abuse.  It was either refused, censored or doctored.   I have obtained documentary evidence that is specific, detailed and unequivocal.

It is therefore critical it be recognized for what it shows and it is morally imperative that those involved be held to account as the documents illustrate clearly and undeniably a collusion between a state PHP and its drug testing lab to fabricate evidence.  The corruption is top-down as it involves another former FSPHP President Luis Sanchez and the VP of Laboratory operations at USDTL Joseph Jones.  As explicit and detailed as it is in revealing unequivocal  black and white crimes it has been ignored by the usual channels.

Research on street criminals suggests the certainty of punishment has the strongest deterrent effect (basically will I be caught) and the more people think they will be arrested for a crime the less likely they are to commit it. Criminals weigh their actions against possible gains and consequences and the risk of consequences in this system have been essentially zero.  Diagnosis rigging, coercion, threats and abuse are rampant because they have no fear of punishment.  The Chairman of the commission that examined the  causes of the 2008 financial collapse compared the  relatively small fines paid by corporations to “someone who robs a 7-Eleven, takes $1,000 and being able to settle for $25 and no admission of wrongdoing.” He added,“Will they do it again? Absolutely, because it pays.” This is like someone who robs a 7-Eleven, takes $1,000 and never gets caught so he goes to the next 7-Eleven and takes $2000 then hits as many 7-Elevens as he can for as much as he can.

Multiple Crimes, Multiple Felonies and Egregious Misconduct.  Fabrication, Falsification, Concealment and Perjured Evidence. Color-of-Law Abuse, Civil Rights Violations 

In June of 2011 I signed a patent-license agreement with a company to bring an epinephrine auto-injector to FDA approval  within three years.  It was recently mentioned in an NBC news article in the wake of Mylan’s Epipen price hike and the patent  documents can be seen here and a slideshare overview here.  This was successfully derailed the following month when I was asked by the state PHP to have an alcohol test.  This was for no apparent reason. I have never been accused of having an alcohol problem and my work performance at MGH was reported as “impeccable.” There were no issues in any arena.  The events are described in detail here, here, and here.

The blood test was reported positive to the medical board on July 19, 2011 as seen here:   positive-peth-july-19-2011    I requested records but PHS refused but relented in December 2011 and I obtained the   USDTL Litigation Packet  which contained a faxed request from PHS to the lab requesting my unique  identification number and a “chain-of-custody” be added to an already positive report See key docs here.:12:3:2011 Litigation Packet (Selected)

The records showed falsely created and fabricated evidence. Clear fraud. I filed a complaint with the College of American Pathologists CAPLetter.  They investigated and forced USDTL to correct the test as reported in an  October 4, 2012 letter from the lab to Sanchez. Instead of revealing the correction the two concealed the revision and reported “non-compliance”  two weeks later  and board took disciplinary action against my license.  In December 2012 CAP contacted me to followup on the outcome of the revised test which I was unaware of.   I informed them they did not tell me and confronted  PHS but they claimed no knowledge of it.. On December 11, 2012 Sanchez reports to the board that he just found out that the test was revised but it had nothing to do with the disciplinary action taken by the board..  Sanchez and Jones deny there was any correction 67-days earlier and stand by their guns.

In August of 2014 I was able to obtain the complete USDTL documents under new HIPPA-Privacy Rule for labs which removed PHS approval.  Full docs can be seen here:  August 6, 2014 to Langan with health materials.   The  October 4, 2012 correction from USDTL to Sanchez  contradicting Sanchez claim of not finding out about the correction until December is included.Note the language used in the  Letter claiming Sanchez was informed of the revised  test 67-days after he actually was.

Recently obtained documents under records reform act –  Langan PDF copy  They show documents entered as evidence date-stamped and entered into the administrative record after the hearings at which they were to be heard.   Multiple others missing and never addressed.   It is now clear that Stoller concealed all documents relating to PHS misconduct since December of 2011.

Specific and detailed evidence of criminal activity was provided to Board Attorney Deb Stoller over the course of more than five-years. This showed clear collusion between the state physician health program and one of their preferred national drug testing labs.  It is important to recognize the gravity of what this means.   I provided a state officer with evidence of crimes similar to Annie Dookhan–clear fabrication and collusion to fabricate evidence. She suppressed it.     This is much much worse than Annie Dookhan as the lab is used by state physician health programs across the country and over the past five-years their have been multiple suicides of doctors who have allegedly been given fabricated drug and alcohol tests just like mine.    Many of these doctors were given positive tests right before they were to complete a 5-year contract and this is a pattern that seems to be occurring as the rule rather than the exception.   Facing five more years of abuse some doctors have chosen to end their lives rather than continue with the PHP.

Specific and detailed evidence of the fraud was given to Deb Stoller over the course of five-years and she did nothing about it to protect Sanchez.   The impact of this is much greater and the consequences much more severe than what occurred with Dookhan.  As The documents clearly showed felony crimes this is egregious and indefensible.

screen-shot-2016-12-09-at-1-14-00-pmWhat is chilling is that this request to falsify evidence was done by fax and the lab complied with full knowledge that the positive-test would result in grave and possibly permanent consequences for someone.  The moral detachment of Jones is incomprehensible to me.  If I was offered a  million dollars at this moment to fabricate a drug test on some stranger I would not do it. I would not for any amount of money and I don not believe the majority of my friends would either.I also contacted Jones (  August 6, 2014 to Langan with health materials ) and told him of the severe consequences this was having for my family but he did not respond.   Had it not been for the new HIPAA -Privacy rule I would never have obtained these documents and without the record reforms act I would never have obtained the evidence implicating Stoller ( Langan PDF copy )

screen-shot-2016-12-09-at-1-13-52-pmIt is now time to enter phase two of exposing the corruption of PHPs. It is now necessary to necessary to relentlessly contradict the lies and falsehoods and and present the evidence with logic and clarity.    It is necessary to name names, point fingers and demand that direct and specific answers to direct and specific questions.  It is time to shine a bright light on the specific  unethical and illegal acts detailed here. They are the rule not the exception and the diagnostic rigging and forensic fraud make these more murders than suicides. This is a public health emergency.   By my estimates over 80% of those being monitored by PHPs do not even meet the diagnostic criteria for substance use disorder or any other psychiatric disorder.  It is political abuse of psychiatry.

screen-shot-2016-04-26-at-10-58-19-pmLegitimate authority has a responsibility to be truthful to one’s words and deeds and policies need to be enforced in a consistent manner.  State PHPs are engaging in fraud in collusion with their preferred drug and alcohol assessment, testing and treatment centers.   They are giving diagnoses to individuals who do not meet the diagnostic criteria for a given diagnosis to provided unneeded treatment. They are financially exploiting doctors under threat of disciplinary action against there medical licenses.

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The Board claims no crimes were committed because no one has been charged with any crimes.  No, Dr. Sanchez has committed very serious crimes including multiple felonies. This can no longer be ignored. These crimes can be determined by the documentary evidence alone. They are self-evident.

To settle the matter once and for all I am offering over $25,000.00 in cool prizes to the first person who can disprove my claim that Dr. Sanchez committed multiple felonies.    My claim is that by simply looking at the dates and documents multiple felonies are clear.  They are not equivocal.  The first person to disprove this assertion may collect each and every item pictured below.  You can even write up a legally binding contract and I will sign it. There is something for everyone and if anyone has any questions about any of it feel free to ask.screen-shot-2016-09-09-at-7-26-42-pm

To summarize,  I can find multiple clear  felonies in the documents that need no further inquiry. They are black letter law and involve fraud, concealment, perjury and other crimes.  Policies and laws need to be enforced equally.   The Board cannot play favorites and give allowances to its friends when it comes to criminal activity.  Sanchez is licensed by the medical board just as I am and the screen-shot-2016-09-09-at-9-08-18-pmboard’s position on the fraudulent practice of medicine is quite clear.

One felony would be demand the board address what is seen here.  Multiple felonies make it inexcusable to ignore and if it is ignored it will be relentlessly addressed again and again and again.   As it is so difficult to obtain evidence it is necessary that this be addressed with full measure as a precedent.  People just like this are harming good doctors across the country and unless you are profiting from the drug and alcohol testing and treatment racket you should be disgusted at what is seen here.   The fact that Sanchez pontificates on the behavior of others makes this particularly egregious.  Moreover, Jones also tests newborns and other groups with these same tests.  If he is this unethical who knows what amount of damage has occurred.  Anyone of integrity and conscience should be outraged by what is seen here.  As it is one of the clearest and most specific examples of laboratory fraud I am going to be asking for help getting this out–it should be used to show how this type of drug and alcohol testing can be abused.

Direct and specific questions deserve direct and specific answers. This will need to be addressed directly as it is not going away and neither am I.   If cannot disprove fewer than three felonies than they need to be addressed.   Suspect similar point-people in other agencies protecting them.

If multiple felonies were not committed then  you would think at this very moment there should be people knocking on the door trying to get my attention so they can collect these prizes.    I don’t hear anybody knocking, do you?

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Prizes as Below

Physician Health Programs: The Need for Transparency and Accountability

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

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

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

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

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

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

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

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

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

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

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

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

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

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


 

PHYSICIAN OR PROFESSIONAL HEALTH PROGRAM SURVEY

Professional Health Program (PHP) Survey

Please click on the link below and complete the following survey if you have been monitored or are being monitored by a PHP.

Professional Health Program (PHP) Survey

This is a confidential survey. If you have concerns about anonymity please create an alternative alias email address (this video shows you how to create an alias G-mail address), then use the alias email address as your “name” for future correlation.

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Transparency and Legitimacy Needed in Addiction Medicine—Answerability and Accountability Absent in Current Paradigm

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?

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What 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.  This is being shown clearly on Medscape as both the Federation of State Physician Health Programs (FSPHP) and the American Society of Addiction Medicine (ASAM) remain silent despite the mounting horror stories from doctors diagnosed with pathology when none existed who were forced into treatment they did not need.  Diagnosis rigging, forensic fraud, lack of due process and all manner of abuse are being reported but as an organization with power maintained by by lack of accountability and secrecy they will not and cannot answer.  It is time we identify these groups as illegitimate and irrational authority and demand transparency and legitimacy.

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Question Authority: The Need for Anti-Authoritarians in the Medical Profession

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Anti-authoritarians question whether an authority is a legitimate one before taking that authority seriously.  images-24To evaluate the legitimacy of  an authority it is necessary to:
1. Assess whether they actually know what they are talking about.   2. Assess whether the authorities are honest in their intentions.
When anti-authoritarians assess an authority to be illegitimate, they challenge and resist that authority.
There is a paucity of anti-authoritarianism in the medical community concerning groups that have gained tremendous sway in the regulation of the medical profession.    There is, in fact, an absence of anti-authoritarian questioning  of  what is essentially illegitimate and irrational authority.
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Most doctors are unaware of the impact these organizations have had on both the regulation of the medical profession and social control of individual doctors.  Through “moral entrepreneurship” and “bent science” these groups have successfully swayed both policy-makers and the public to support an agenda not supported by reality testing or critical thinking.  This acceptance without investigation has led to a deterioration of professional ethics and evidence-based decision making in the regulation of the medical profession.
 In order for these organizations to maintain power it is necessary that their authoritative opinion remain unquestioned and unchallenged.  Consciously manufactured propaganda has persuaded regulatory and public opinion of their value and to maintain power it is necessary that this authority remain insulated from outside evaluation because the entire system is based on assumptions that can be aptly characterized as “illusions.
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The dogmatic statements and abusive generalizations do not conform to reality.
Everything is adapted to an existing stagnant cognitive system that falls far off the map of the scientific approach to information and evidence based medicine.  Perceiving only confirmations the physician health paradigm embodies and expresses preconceived ideas, values and mentalities based on certitude and absolute truth.

If one looks behind the curtain there is not much there.   Screen Shot 2015-06-16 at 3.39.59 AM

Historical, political, economic and social analysis can all show how the construct that exists today came to be.   This can be factually ascertained by simple reasoning and examination of the documentary evidence.

Any one of these analyses would reveal that the “PHP-blueprint” is a false-construct built on circumnavigation and obfuscation.

An evidence-based scrutiny of the literature would reveal it to be invalid and of little probative value.  A public policy analysis would reveal the logical fallacies involved in trumpeting  their positions including exaggerated rhetoric and  fear monitoring strategies designed to inspire moral panics and exploit fears to further an underlying political agenda

Any critical analysis would reveal cherry picking. proof by anecdote, deceptive propaganda, double talk, contradictory, illogical and incomprehensible jabber,  unprovable and  un-disprovable statements and a panoply of logical fallacy.

These groups  misrepresent, censor and suppress. They  nit pick and split hairs.  Screen Shot 2015-06-16 at 3.40.37 AMThe concept of denial is not just used to force people into treatment and justify abuse during treatment but  to suppress specific questions and deliberately avoid key facts.

So why are we not questioning this “authority?”     They have been left alone and basically thrown in the backyard left to proliferate like feral cats.

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We need anti-authoritarians and we need them now.

I need allies before the door closes for good. And that door may be closing a lot sooner than you think!

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The Need to Speak up Against Bad Science, Bad Medicine, Bad Policy and Bad Actors–Neutrality is not an Option. Use Your Voice and Question Authority!

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

So what are the barriers?

Why has this not been done?

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

So what can we do about it?

The first “step into the breach” is to identify the problem with the first one being the Emperor has no clothes. Once this is acknowledged it would not take long to address directly the specific problems and erroneous assumptions of this paradigm through the lenses of science, critical reasoning, ethics and common sense. If this were to be done the entire Potemkin village would fall like a house of cards.Screen Shot 2015-06-15 at 12.05.53 AM

But the very first and simplest step is to use your voice to question this authority. Neutrality is not an option.   Either support what these groups are doing or question them with your voice and the written word.

The bad science, medicine, policy and actors are obvious.   It would be like shooting fish in a barrel and the first target needs to be the “PHP-Blueprint.”   It would be so easy to take down this “research” they are using to promote PHPs as a “gold-standard” and replicable model.  Shooting fish in a barrel requires someone take aim and at this point hardly anyone is even willing to pick up the gun.

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Disrupted Physician

Drug Companies and Doctors: A Story of Corruption.

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

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

And unlike the pharmaceutical industries carefully constructed “bent science” which requires a keen eye and critical analysis , the evidence-base supporting the testing, assessment and treatment industry rests on a foundation that can…

View original post 541 more words

The Medical Profession under Dictatorship–Revisiting Dr. Leo Alexander’s prescient warnings from 1949

“Let it be considered, too, that the present inquiry is not concerning a matter of right, if I may say so, but concerning a matter of fact.”–Adam Smith

“Most men endure the sacrifice of the intellect more easily than the sacrifice of their daydreams.  They cannot bear that their utopias should run aground on the unalterable necessities of human existence”  -Ludwig von Mises

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“Science under dictatorship becomes subordinated to the guiding philosophy of the dictatorship.” So begins Medical Science Under Dictatorship1 written in 1949 by Leo Alexander and published in the New England Journal of Medicine. Alexander acted as consultant to the Secretary of war and the Chief Counsel for the Nuremberg trials.

The guiding philosophic principle is Hegelian or “rational utility” and “corresponding doctrine and planning”, Alexander said “replaced moral, ethical and religious values” and Nazi propaganda was highly effective in perverting public opinion and public conscience. He explains how this expressed itself in a rapid decline in standards of professional ethics in the medical profession.   This all “started from small beginnings” with subtle shifts in the attitudes of physicians to accept the belief that there is such a thing as “a life not worthy to be lived.”

In 1985 the British Sociologist G.V. Stimson wrote of a new form of professional control in the United States that had emerged in the preceding decade whose “success rests on the ability to take certain areas of conduct such as alcoholism and drug abuse (which are formally disciplinary issues) and handle them as diseases.”2

Stimson writes:

“The impaired physician movement is characterized by a number of evangelical recovered alcoholic and addict physicians, whose recovery has been accompanied by an involvement in medical society and treatment programs. Their ability to make authoritative pronouncements on physician impairment is based on their own claim to insider’s knowledge.”2

Among these authoritative pronouncements was the use of specialized treatment centers. Many professionals were critical of these programs including Assistant Surgeon General John C. Duffy who criticized the “boot-camp mentality”4 toward doctors and American Society of Addiction Medicine President Leclair Bissel who when asked in a 1997 interview when the field began to see physicians as a specialized treatment population replied “when they started making money..” .” 5

Amid reports of abuse, coercion and control in facilities using a doctor’s medical license as “leverage,” the Atlanta Journal Constitution ran a series of reports in 1987 documenting the multiple suicides of health care practitioners at one of these programs (5 while in the facility and at least 20 after discharge).6   Neither these suicides nor a large settlement against the same facility (finding a non-alcoholic doctor was intentionally misdiagnosed as an alcoholic and forced into months of treatment)  for fraud, malpractice, and false imprisonment involving intentional misdiagnosis7 generated any interest among the medical community at large.

And by 1995 the door had closed as the Federation of State Physician Health Programs ( FSPHP ) relationship with the Federation of State Medical Boards (FSMB), the national organization responsible for the licensing and discipline of doctors,  was forged.  A 1995 issue of The Federal Bulletin: The Journal of Medical Licensure and Discipline, contains articles outlining the high success rates of these programs in 8 states with an editorial comment from the FSMB that concludes:

“cooperation and communication between the medical boards and the physician health programs must occur in an effort to protect the public while assisting impaired physicians in their recovery.”8

The Federation of State Medical Boards (FSMB) has approved any and all policy and regulation put forth by the impaired physician movement  then organized under the Federation of State Physician Health Programs (FSPHP) with no apparent inquiry or opposition.

In 2003 Dr. Gregory Skipper, one of the key players of the impaired physician movement partnered with NMS labs to develop the alcohol metabolite ethyl-glucuronide (EtG) as a laboratory developed test13 14 he proposed be used as a monitoring tool for covert alcohol use in physicians after a pilot study involving just 14 psychiatric inpatients.15

The policy entrepreneurship this group so effectively uses to advance their goals can be seen in the August 25, 2004 Journal of Medical Licensure and Discipline which contains articles both presenting the problem 11 and providing the solution.11   The EtG was then introduced as an accurate and reliable indicator of covert alcohol use and the impact of this cannot be underestimated as it introduce to the market not only unregulated non FDA approved tests for forensic use but tests reaching further back into history then those used by workplace drug-testing programs.

The limitations of any test needs to be understood both in the forensic and clinical context but there is a lot less flexibility in the forensic context when people’s liberties, freedoms or property rights ( as with a medical license) are in jeopardy.

Sensitivity and specificity need to be carefully considered.  The positive predictive value of a test is the true positives over the true positives plus false positives.  If you are going to sanction somebody as a result of a single test that test needs to have 100% sensitivity.

When workplace drug testing was introduced debates over both the accuracy and scope of tests occurred. The employees right to privacy and the employers right to have a drug-free workplace were discussed with the general consensus being testing for impairment was a legitimate concern but preservation of private life should remain.

What was done here dissolves both.

PHP programs require abstinence from all substances including alcohol and strict adherence to 12-step doctrine9 yet many of the physicians monitored by them are neither addicts nor alcoholics. Requiring abstinence from drugs and alcohol while using non-FDA approved Laboratory Developed Tests in monitoring programs is a dangerous combination. The suicides reported by the Atlanta Journal Constitution in 1987 were prior to the introduction of these tests. Adding these tests of unknown validity to an already abusive program of coercion and control would only worsen the situation.

I have been hearing of multiple suicides involving both the fear of results and false results. I have also been hearing of doctors who have killed themselves because they were suffering from depression but did not seek help as their fear of being ensnared into the PHP outweighed the need to get help.

Three decades after G.V. Stimson so accurately defined the impaired physician movement the impaired physician movement defines the professional control of medicine..   Their involvement in medical society physician health programs (PHPs) and treatment programs has evolved into absolute control of both. Pronouncements on physician impairment have evolved from insider’s claims to written edict.   And their reach has extended from impairment due to drugs and alcohol to “potential impairment” and “relapse without use.” Their reach has extended from drug and alcohol impairment to all other aspects of medicine and the impact has been profound.   Medicine has been subordinated to the guiding philosophy of the impaired physician movement and doctors are dying in droves du to institutional injustice.

How does the profession of medicine reconcile the fact that we have allowed an as yet non ABMS recognized “self-certification” specialty full reign over those who are ABMS recognized?  How is it that we allow non-FDA approved Laboratory Developed Tests (LDTs) of unknown validity on doctors coerced into state Physician Health Programs (PHPs)?    A recent debate in Washington calling for regulation of  “clinical”  LDTs just took place and the fact that they are being used for “forensic” purposes in doctors is incomprehensible.   Has anyone noticed it is the same people introducing the tests who are claiming PHPs are the “gold standard,” trying to push them on other EAPs and calling for more widespread use of these tests?

The use of non-FDA approved Laboratory Developed Tests (LDTs) for drug and alcohol testing  is currently limited to PHPs and the criminal justice system. (i.e. monitoring programs in which those doing the testing have power and those being tested have no power). That may soon change. See  Drug Testing and the Future of American Drug Policy and The American Society of Addiction Medicine White Paper on Drug Testing describing the plans for widespread expansion of this drug testing to other groups including kids.

Those involved in the Massachusetts General Hospital Laboratory Medicine, Toxicology and addiction medicine departments looked critically at these tests and decided hands down against using them. Why? Because no evidence base exists and the potential harm far outweighs any perceived benefit.  “Research” has been done on those being monitored by PHPs and the criminal justice system and Drs. J Wesley Boyd, M.D., PhD, and John Knight, M.D. of Harvard Medical School who collectively have over two decades of experience as Associate Directors with the Massachusetts PHP, Physician Health Services, Inc. addressed this research in a 2012 article published in the Journal of the American Society of Addiction Medicine entitle Ethical and Managerial Considerations Regarding State Physician Health Programs.  The allegations that PHPs are engaging in research in violation of the Nuremberg code ( that was a direct result of the Nuremberg trials for which Dr. Alexander acted as consultant ) should have raised some eyebrows.   It hasn’t.

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What do you think will happen when ASAM gets recognized by the ABMS in 2 years as is expected?   These “addiction medicine” specialists will inevitably join hospital formulary , clinical lab, toxicology and ethics panels to do the same thing they have done to get where they are today.   They will do the same thing they have done with state PHPs.  Those with a hidden agenda will be able to outvote those of good conscience and thoughtful intelligence and patient care will then be subordinated to the guiding philosophy of the impaired physicians movement.

This system of institutional injustice is killing doctors by suicide as the medical societies and Departments of Public Health have given PHPs full autonomy and authority and it is poised to impact patient care.

I challenge you to name any other company, organization, group or agency within or related to the profession of medicine and the field of science that is bereft of absolutely all  transparency,  regulation or oversight?  It does not exist.

The PHP scaffold has deliberately  removed themselves from all aspects of accountability including answerability, justification of actions and the ability of outside actors to hold them in judgment of any information provided by answerability.   Heads I win, tails you lose.   That is a big red flag in itself. and those not currently being held accountable they may very well be after you next as their plans include expansion to other groups includes EAPs, the Department of Transportation, athletes, students and even kids!

Doctors are afraid to talk about this for fear of being ensnared themselves.  Those already in these programs will not speak for fear of punishment. This is a legitimate concern and needs to be discussed openly and publicly.  I need allies!

 Help me get the word out –too many doctors are dying.  Three died by suicide in one month alone who were being monitored by the Oklahoma PHP and these suicides did not even make the local papers let alone national news!     They need to.

In The Argument of Fascism Ludwig von Mises wrote:

It cannot be denied that Fascism and similar movements aiming at the establishment of dictatorships are full of the best intentions and that their intervention has, for the moment, saved European civilization. The merit that Fascism has thereby won for itself will live on eternally in history. But though its policy has brought salvation for the moment, it is not of the kind which could promise continued success. Fascism was an emergency makeshift. To view it as something more would be a fatal error.

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Monopolies, Self-Referral and Shell Games: The Need for Antitrust Investigation of Physician Health Programs and their “PHP-Approved” Assessment and Treatment Centers

On the above list can be found the Medical Directors of a number of drug and alcohol rehabilitation facilities. I did not make up this list. An updated version can be seen right here on the “like-minded doc” website.

Talbott, Marworth, Hazelden, Promises, and another two-dozen or so “PHP-approved” assessment and treatment centers are represented on this list. State Physician Health Programs (PHPs) refer doctors to these facilities for evaluations. PHPs are non-profit tax-exempt organizations. They do not evaluate or treat patients. If a physician is referred to a PHP for a suspected problem the assessment must be done at an outside facility which will invariably be linked to a name on the list of Like-Minded Docs.

What most people do not know, however, is that this is an exclusive arrangement. Evaluations are constrained to one of these facilities. It is mandated. No bargaining. No compromises. No choice. In other words it is a coercion.

Disrupted Physician

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

“PHP-Approved” Assessment and Treatment Centers

On the above list  can be found the Medical Directors of a number of drug and alcohol rehabilitation facilities.  I did not make up this list.  An updated version can be seen right here on the “like-minded doc” website.

Talbott, Marworth, Hazelden, Promises, and another two-dozen or so “PHP-approved”  assessment and treatment centers are represented on this list.    State Physician Health Programs (PHPs) refer doctors to these facilities for evaluations.  PHPs are non-profit tax-exempt organizations.  They do not evaluate or treat patients.   If a physician is referred to a PHP for a suspected problem the assessment must be done at an outside facility which will invariably be linked to a name on the list of Like-Minded Docs.

What most people do not know, however, is that this is an exclusive arrangement.    Evaluations are constrained to one of these facilities…

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Drug Companies and Doctors: A Story of Corruption

Drug Companies and Doctors: A Story of Corruption.

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

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

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

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

So what are the barriers?

Why has this not been done?

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

So what can we do about it?

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

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

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


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

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

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

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


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