Moral Crusades and Moral Panics as a Means of Social Control in the Medical Profession

IMG_9005The Medical Profession, Moral Entrepreneurship, and Social Control

Sociologist Stanley Cohen  used the term “”moral panic” to characterize the amplification of deviance by the media, the public, and agents of social control.1  Labeled as being outside the central core values of consensual society, the deviants in the designated group are perceived as posing a threat to both the values of society and society itself.   Belief in the seriousness of the situation justifies intolerance and unfair treatment of the accused.   The evidentiary standard is lowered.

Howard Becker describes the role of “moral entrepreneurs,” who crusade for making and enforcing rules that benefit their own interests by bringing them to the attention of the public and those in positions of power and authority under the guise of righting a society evil. 2

And according to cultural theorist Stuart Hall, the media obtain their information from the primary definers of social reality in authoritative positions and amplify the perceived threat to the existing social order. The authorities then act to eliminate the threat.3  The dominant ideas or ideologies are reproduced by relying on the opinions of the defining authority and then spread through the media. The communal good has been assailed.

As a society governed by organizations, associations,  institutions and regulatory bodies, the medical profession is not immune to “moral panics.”  A threat to patient care or the values of the profession can be identified and amplified.   A buildup of public concern fueled by media attention ensues creating a need for governing bodies to act. Medical Professionalism and the Public Health has been assailed.

Unbeknownst to the general public and most members of the medical profession at large, certain groups have gained tremendous sway within medical society. Through  moral entrepreneurship they have gained authority and become  the primary definers of the governance of the medical profession and the social control of  doctors.  To benefit their own interests they have fostered and fueled “moral panics” and “moral crusades. ” Exhorting authorities to fight these  threats by any means necessary  they have successfully made and enforced rules and  regulations and introduced new definitions and tools with no meaningful resistance or opposition.

The Inquisition did not have to convince  individual citizens or the general public of their beliefs to advance an agenda; just Ecclesiastical and Political Authority.  Similarly, the  “impaired physicians movement” did not have to convince individual doctors or the medical profession of their beliefs  to further a self-serving agenda; just  regulatory and administrative authority.

Addiction Medicine Monopoly, False Authority and Conflicts of Interest

The “impaired physicians movement” can be defined as a group of physicians with alcohol and substance abuse problems who, having found sobriety through 12-step spirituality, banded together to promote the ideology behind their personal  “recovery”  to other doctors and the medical community at large. In the 1980s the movement gained momentum and as their numbers grew  began calling themselves  specialists in “addiction medicine.”  The American Society of Addiction Medicine (ASAM)  is not a true specialty, but a Self-Designated-Practice-Specialty, which simply means that is what they are calling themselves.  It reflects neither knowledge nor expertise..  “Board certification” by the American Board of Addiction Medicine (ABAM) is not recognized by the American Board of Medical Specialties (ABMS).

ABAM certification requires only a medical degree, a valid license to practice medicine, and completion of residency training in ANY specialty.  Addiction Psychiatry, a subspecialty of psychiatry under the American Board of Neurology and Psychiatry  is the only  specialty recognized by the ABMS. and their specialty society is the American Academy of Addiction Psychiatry.

The ASAM is schooled in just one one uncompromising model of addiction with the majority attributing their very own sobriety to that model–the chronic relapsing “brain disease” with lifelong abstinence and 12-step spiritual recovery model.   As the “voice of addiction medicine,” the ASAM has nevertheless defined the dominant treatment paradigm in the United States.   ASAM doctors outnumber addiction psychiatrists by 4:1 and the movement is well funded.   Because addiction is defined as a “disease”, addicts must be “treated” (more often coercive than voluntary), and “cured” (defined as abstinent).  The billion dollar  assessment and treatment industry and the drug and alcohol testing industry  lucratively profits from this model which has grown to monopolize addiction treatment  in the United States.

The goal of the ABAM Foundation is to “gain recognition of Addiction Medicine as a medical specialty by the American Board of Medical Specialties (ABMS).”   A monopoly defined by self-appointed experts without recognized  specialty training will soon likely Robber baron their way to being accepted as  a true specialty.

Physician Health Programs, Regulatory Agencies, and Treatment Centers

Physician Health Programs (PHPs) meet with, assess, and monitor doctors who have been referred to them for substance use or other mental or behavioral health problems. Unless being monitored by one, PHP practices are unknown to most physicians and operate outside the scrutiny of the medical community.  Initially funded by State Medical Societies and staffed by volunteer physicians,  PHPs  served the dual function of helping sick doctors and protecting the public.

As the populations of ASAM physicians proliferated  in the 1980s, many  joined their state Physician Health Programs. PHP doctors who did not agree with the ASAM groupthink were gradually removed  and they  organized under the Federation of State Physician Health Programs(FSPHP).  Other ASAM physicians found employment at treatment centers as staff physicians and medical directors.

The FSPHP cultivated a relationship with the  Federation of State Medical Boards (FSMB) and the state PHPs formed alliances with their  state medical boards. Promoting themselves as offering “treatment” rather than”punishment” they offered an alternative to disciplinary action.  They then began promoting their successful outcomes  in rehabilitating “impaired physicians”,  and this history can be seen by examining the archives of the Journal of Medical Regulation and similar  publications.  In 1995 the   Washington  PHP claimed a success rate of  95.4%,   Tennessee  claimed 93% and Alabama 90%.

Part of this success was attributed  to the specialized  treatment centers for doctors directed by their ASAM colleagues such as  Ridgeview Institute in Atlanta created by G. Douglas Talbott.  Talbott, who helped organize and serve as past president of the ASAM claimed a 92.3 percent recovery rate. He also put forth a Medical Urban Legend–the proposition that doctors were a different species, separate from the rest of society, who needed special treatment three times longer than anyone else.  Amazingly, this dicto simpliciter argument that can, in fact, be refuted simply by pointing it out  was allowed to enter regulatory medicine unopposed.  Simply because, sadly, no one ever pointed out the logical fallacy. It is now entrenched.    Three months or more of treatment is  standard of care for our profession. They did this by getting medical boards and the FSMB to accept fantasy as fact by relying on board members tendency to accept expert evidence at face value.

Physicians are unique only insofar as the unique elements required of the profession to become and be a physician such as going to medical school and completing the required board examinations.  That’s it.    I implore anyone to put forth any sound argument based on science and evidence that justifies a thrice lengthy stay in medical professionals.  Not gonna happen.   Thought stopping memes and logical fallacy is the best they have to offer.  And, unfortunately this type of  rabbling gibberish cuts the mustard in the regulatory medicine venue.   A “low-bar” evidentiary standard is not the problem.  If you look at the documentary evidence from a medico-historical perspective there never was a bar.  The FSMB has essentially given the impaired physicians movement carte blanche authority and unrestrained managerial prerogative.  A bar never even existed.  It’s a laissez-faire Lord of the Flies free-for-all.    The logical fallacy of appeal to authority–illegitimate and irrational authority.  Bamboozled by smoke and mirrors.

A 1995 issue of the FSMB publication  The Federal Bulletin: The Journal of Medical Licensure and Discipline contains reports on eight  separate state  PHPs.   The “almost 90% success rate” was  applauded by the editor, who added  “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.”   And more recent reports suggest PHPs   reduce malpractice claims. They are now being promoted as a replicable model  to be used in other populations.

The problem is no one bothered to examine the methodology to discern the validity of these claims.  There has been no critical analysis or Cochrane type review of any of these studies which are invariably small, methodologically flawed, and biased.

The FSMB has accepted them as  expert authority and  their authoritative opinion as fact.  It  is this acceptance of faith without objective assessment that has allowed the ASAM and FSPH to advance their agenda. By  confusing ideological opinion  with professional knowledge, the FSMB and state Medical Boards have acted as willing gulls each step of the way. No counter-forces existed.  And they still don’t.   Junk science and unvalidated neuropsychological testing is used by these groups unconstrained and willfully.  There is no regulation, oversight, or accountability.  They are using polygraph testing (despite the AMA’s previous public policy statement deeming it junk) to both condemn “disruptive” surgeons and deem convicted pedophiles fit to return to work.  They have introduced junk-science in drug and alcohol testing and unvalidated “neuropsychological” testing to detect “character-defects” by getting regulatory agencies to accept the validity of these tests not by the Scientific Method or Evidence Based Research but by (to coin a term) “Regulatory Sanctification”

To paraphrase one FSPHP member,   “Who needs evidence-based medicine when the boards have already accepted these tests as valid?”  Who indeed?

The ideological bias and financial conflicts of interest between PHPs and the  treatment centers was also not recognized. It still isn’t.  The  spotlights are apparently all  on Big Pharma  in this regard.    Some sunlight needs to be exposed in the direction of the billion dollar drug and alcohol testing and assessment industry as well.

Doctors  were held at Ridgeview three times longer than the rest of the population (and at three times the cost)  under threat of loss of licensure.   Although there is no evidence base or plausible explanation why an entire profession would have a three-times  longer length of stay than the rest of the population this continues to be the reality. There is no choice.

in 2011 The ASAM issued a Public Policy Statement on coordination between PHPs, regulatory agencies, and treatment providers recommending  that  only “PHP approved” treatment centers be used in the assessment and treatment of doctors.  It specifically excludes non “PHP -recognized” facilities.  And what defines a “PHP approved” treatment center?    In addition to finding essentially no oversight by the state medical society and medical board, a recent audit of the  North Carolina PHP found financial conflicts of interest and no  documented criteria for selecting the out of state treatment centers they used.  The common denominator the audit missed was that the 19  “PHP-approved” centers were all ASAM facilities just like Ridgeview whose medical directors can be seen on this list.

The appeal to authority logical fallacy has enabled the FSPHP to become the expert authority on physician impairment through the eyes of the medical boards.  It has also allowed them to increase their scope.

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

According to the FSPHP, physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years.”

The policy extends PHP authority to cover physical illnesses affecting cognitive, motor, or perceptive skills, disruptive physician behavior, and “process addiction” (compulsive gambling, compulsive spending, video gaming, and “workaholism”). It also defines “relapse without use” as “behavior without chemical use that is suggestive of impending relapse.”

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

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

Inherent in this model is the importance of external control.  It gives them power to exert control over the individual regardless of whether they need to be treated.

By bamboozling regulatory medicine this was accomplished.    And the maintenance of this relationship is necessary as this  presentation  by an FSPHP physician  warns, “guard this relationship jealously.”

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Moral Panics and Moral Crusades

By introducing and fueling moral panics the ASAM/FSPHP political apparatus has been able to expand in both scope and power.

The Medscape article “Drug Abuse Among Doctors:  Easy, Tempting, and Not Uncommon”published in the “Business of Medicine” section in January 2014 is characteristic example of the authoritative opinion, propaganda, and misinformation spun to maintain a pervasive climate of fear. Proof by anecdote.  Physicians are “5 times as likely as the general public to misuse prescription drugs” according to Lisa Merlo, PhD.  “Given the epidemic of prescription addiction sweeping the nation, that’s a grim statistic.”

Described as a “researcher at the University of Florida’s Center for Addiction Research and Education,” Merlo’s research involving 55 doctors being monitored by their state Physician Health Program published in the Journal of Addiction Medicine in October 2013 found “most physicians who abuse prescription drugs” do so to “relieve stress and physical or emotional pain.”  Nowhere is it mentioned on Medscape that Merlo is the Director of Research for the Florida state PHPProfessionals Research Network.   Physician access to medications through prescriptions,  “networks of professional contacts, and proximity to hospital and clinic supplies” gives them “rare access to powerful, highly sought-after drugs” says Marvin D. Seppala, chief medical officer at Hazelden.  This access “sets them apart” and “not only foment a problem” but”perpetuate it” says Seppala.  “Access “becomes an addict’s top priority” and they “will do everything in their power to ensure it continues.”  

“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.” Physicians are intelligent and skilled at hiding their addictions, he says. Few, no matter how desperate, seek help of their own accord.”  In reality this is absurd.  And if you look at any of the current “moral panics” that are being used to suggest random suspicion-less drug testing of all doctors or promoting the Physician Health Programs as the “New Paradigm” you will inevitably find a doctor, just like Marv Seppala who is on this list as  an author or interviewee.  It is a given.

The terms  “impaired physician” and  the “disruptive physician”  are used as labels of deviancy.  As deviants who allegedly threaten the very core of medicine (patient care) and  the business of medicine (profit)  they must be stopped at all costs.   Belief in the seriousness of the situation justifies intolerance and unfair treatment.  The evidentiary standard is lowered.  Aided by a  “conspiracy of silence” among doctors in which impaired colleagues are not reported  necessitates identification of them by any means necessary.   Increase the grand scale of the hunt.

In this way these front-groups have successfully acted as moral entrepreneurs to make and enforce rules and put forth new definitions and mandates that serve their own interests.     A retrospective non -blinded non-randomized cohort study with serious underlying methodological errors involving 904 physicians being monitored by PHPs is now being used to “set the standard for recovery.”

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Across the Country doctors are going to the media,  law enforcement, the AGO, and the ACLU only to be turned a deaf ear.   Many consider this a “parochial” issue best handled by the medical community. Doctors reporting crimes are turned back over to the very perpetrators of the crimes.   The Medical Societies and professional organizations contribute to the problem by willful ignorance.   Accusations are used to disregard the claims of the accused.   It is a system of institutional injustice that is driving many doctors to suicide.  Hopeless, helpless, and feeling entrapped many are taking this route.  And no one is talking about it.   This cannot be avoided any longer.

The next target is the “aging physician.”   And as they have done with the “impaired” and “disruptive” physician” the FSPHP and their affiliates are setting the stage for another “moral crusade.”

  1. Cohen S. Folk Devils and Moral Panics: The Creatio of the Mods and Rockers (New Edition).Oxford, U.K.: Martin Robertson; 1980.
  2. Becker H. Outsiders: Studies in the Sociology of Deviance. New York: Free Press; 1963.
  3. Hall SC, Critcher C, Jefferson T, Clark J, Roberts B. Policing the Crisis: Mugging, the State, and Law and Order. London: Macmillan; 1978.

 

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The “Impaired Physician Movement” takeover of state Physician Health Programs (PHPs).

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“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.”–G.V. Stimson  (1)

Forget what you see; Some things they just change invisibly–Elliott Smith (Between the Bars)

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Physician Impairment

The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence, published by the American Medical Association’s (AMA) Council on Mental Health in The Journal of the American Medical Association in 1973, (2)  recommended that physicians do a better job of helping colleagues impaired by mental illness, alcoholism or drug dependence. The AMA defined an “impaired physician” as “a physician who is unable to practice medicine with reasonable skill and safety to patients because of mental illness or excessive use or abuse of drugs, including alcohol.”

Recognition of physician impairment in the 1970s by both the medical community and the general public led to the development of “impaired physician” programs with the purpose of both helping impaired doctors and protecting the public from them.

IMG_1010The 1975 media coverage of the deaths of Drs. Stewart and Cyril Marcus brought the problem of impaired physicians into the public eye. IMG_0940Leading experts in the field of Infertility Medicine, the twin gynecologists were found dead in their Upper East Side apartment from drug withdrawal that New York Hospital was aware of but did nothing about. Performing surgery with trembling hands and barely able to stand, an investigation revealed that nothing had been done to help the Marcus brothers with their addiction or protect patients. They were 45 –years old.

Top: Twin Gynecologists Stewart and Cyril Marcus Bottom: The Movie

Top: Twin Gynecologists Stewart and Cyril Marcus
Bottom: The Movie “Dead Ringers” starring Jeremy Irons based on the Marcus twins

Although the New York State Medical Society had set up its own voluntary program for impaired physicians three years earlier, the Marcus case prompted the state legislature to pass a law that doctors had to report any colleague suspected of misconduct to the state medical board and those who didn’t would face misconduct charges themselves.


Physician Health Programs

Physician health programs (PHPs)  existed in almost every state by 1980. Often staffed by volunteer physicians and funded by State Medical Societies, these programs served the dual purpose of helping sick colleagues and protecting the public. Preferring rehabilitation to probation or license revocation so long as the public was protected from imminent danger, most medical boards accepted the concept with support and referral.

As an alternative to discipline the introduction of PHPs created a perception of medical boards as “enforcers” whose job was to sanction and discipline whereas PHPs were perceived as “rehabilitators” whose job was to help sick physicians recover. One of many false dichotomies this group uses and it is perhaps this perceived benevolence that created an absence of the need to guard.


Employee Assistance Programs for Doctors

Physician Health Programs (PHPs) are the equivalent of Employee Assistance Programs (EAPs) for other occupations. PHPs meet with, assess, and monitor doctors who have been referred to them for substance use or other mental or behavioral health problems.

Most EAPs, however, were developed with the collaboration of workers unions or some other group supporting the rights and best interests of the employees. PHPs were created and evolved without any oversight or regulation.

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The American Society of Addiction Medicine can trace its roots to the 1954 founding of theNew York City Medical Society on Alcoholism (NYCMSA) by Ruth Fox, M.D whose husband died from alcoholism.

The society, numbering about 100 members, established itself as a national organization in1967, the American Medical Society on Alcoholism (AMSA).

By 1970 membership was nearly 500.

In 1973 AMSA became a component of the National Council on Alcoholism (NCA) in a medical advisory capacity until 1983.

But by the mid 1980’s ASAM’s membership became so large that they no longer needed to remain under the NCADD umbrella.

In 1985 ASAM’s first certification exam was announced. According to Dr. Bean-Bayog, chair of the Credentialing Committee, “a lot of people in the alcoholism field have long wanted physicians in the field to have a high level of skills and scientific credibility and for this body of knowledge to be accredited” (3).   And in 1986 662 physicians took the first ASAM Certification Exam.

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By 1988 membership was over 2,800 with 1,275 of these physicians “certified” as “having demonstrated knowledge and expertise in alcoholism and other drug dependencies commensurate with the standards set forth by the society.” (4)  The formation of State Chapters began with California, Florida, Georgia, and Maryland submitting requests.(5)

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In 1988 the AMA House of Delegates voted to admit ASAM to the House. According to ASAM News this “legitimizes the society within the halls of organized medicine. (3)
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By 1993 ASAM had a membership of 3,500 with a total of 2,619 certifications in Addiction Medicine. The Membership Campaign Task Force sets a goal to double its membership of 3,500 to 7,000 by the year 2000 to assure “the future of treatment for patients with chemicals. It represents a blueprint for establishing addiction medicine as a viable entity.” (6)

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Many of these physicians joined state PHPs and over time have taken over under the umbrella of the FSPHP.

Others became medical directors of treatment centers such as Hazelden, Marworth and Talbott.


1. Stimson GV. Recent developments in professional control: the impaired physician movement in the USA. Sociology of health & illness. Jul 1985;7(2):141-166.

2. The sick physician. Impairment by psychiatric disorders, including alcoholism and drug dependence. JAMA : the journal of the American Medical Association. Feb 5 1973;223(6):684-687.

3. Four Decades of ASAM. ASAM News. March-April 1994, 1994.

4. American Medical Society on Alcoholism & Other Drug Dependencies Newsletter. Vol III. New York, NY: AMSAODD; 1988:12.

5. AMSAODD News. Vol III. New York, NY: American Medical Society on Alcoholism & Other Drug Dependencies; 1988.

6. Membership Campaign Update. ASAM News. Vol VIII: American Society of Addiction Medicine; 1993:11.

Snakes in Smocks: Unrecognized Corporate Psychopathy in the Medical Profession

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A 2010 study, Corporate Psychopathy: Talking the Walk, found that 3 to 6 percent of corporate employees may be responsible for the majority of ethical breaches in corporations, with corporate psychopathy tending to be concentrated at the higher levels of organizations.

This group here, Like-minded Docs,  is largely responsible for what happens to any doctor referred to a state PHP because all of the medical directors of  the “PHP-approved” assessment and treatment centers can be found right here.

So too can Bob Dupont and Greg Skipper who have introduced the non-FDA approved drug and alcohol LDTs.  Stuart Gitlow, President of ASAM is also on the list.

This group is essentially in control of doctors and determines their fates and the percentage of psychopathy here is much much more than the  3-6% found at Enron.

Some of these doctors have done horrible things that most doctors would never do under any circumstances (steal IV pain relieving drugs from dying cancer patients I.V. bags, selling the ‘date-rape” drug to DEA agents).

On this list are multiple felons and a fair number of double felons who got their licenses back by saying they were not responsible for what they did.  They were helpless over drugs or alcohol and have now been saved by the good graces of 12-step spirituality.

And with that the medical boards gave them power without accountability.  There is no regulation, oversight, answerability or need to justify their actions.  It is a free for all and this list is a gold-mine for anyone studying organized psychopathy.

Physician Health Programs are a funnel for the sociopath and without restraint they are only growing.

This is what John Nash described would happen without counter-forces to keep their numbers low.


Psychopathy

Psychopathy is present in all professions. In The Wisdom of Psychopaths: What Saints, Spies, and Serial Killers Can Teach Us About Success, Kevin Dutton provides a side-by-side list of professions with the highest (CEO tops the list) and lowest (care-aid) percentage of psychopaths.   Interestingly surgeons come in at #5 among the professions with the highest percentage of psychopathy while doctors  (in general) are listed among the lowest.

Although by no means a scientific study, Psycopaths, by their very nature, seek power and it would make sense that a psychopath among us might pick surgery over pediatrics or pathology as they are drawn to power, prestige, and control. Be this as it may the incidence of psycopathy or psychopathic traits in doctors of any specialty is low. Statistics indicate that no more than 1% of men in general exhibit psychopathic traits. In Women these characteristics are far less.

Due to irresponsible behavior and a tendency to ignore or violate social conventions and rules,  psychopaths frequently find themselves engaged in conduct involving the criminal justice system or involved in other disciplinary action. Juvenile delinquency, arrests, school suspensions and misconduct related issues are barriers that preclude professional careers for many and, with around 15% of the prison population estimated to be psychopathic, incarceration and recidivism are common final pathways. Because of this tendency it would be highly unlikely for most sociopaths to follow a standard professional career pathway involving academic rigor and normal professional and societal expectations,  because impulsive irresponsible actions commonly blocks it. This would predict a probably much lower prevalence of psycopathy in physicians compared to the general population.

That being said, such self imposed removal from a potential  career is the sole product of getting caught for misconduct and being held accountable for it.   Psychopaths possess several traits that make this difficult.    With a talent for “reading people” and identifying their weak spots and vulnerabilities they are able to get people to see what they want them to see.  Psychopaths often exude charm, confidence and charisma.  They can lie effortlessly and are very convincing..

The natural history of psychopathy involves risky behavior and the ability to get away with it or out of it. The consequences of this depend on if and when it occurs. It is entirely conceivable that some may live their entire lives undetected. With a need for stimulation and a proneness to boredom the psychopath is particularly prone to drug abuse and addiction and twice as likely as the general population to be diagnosed.

 Psycopathy involves a path of risky behavior as well as the potential for being held accountable for it. At any age the behavior that brings they psychopath to the attention of the criminal justice system is often drug or alcohol related. The natural history of the average psychopath reveals an overrepresentation in prison with a 15x greater risk in general. Any statistics on psycopathy in a population is based on psychometric evaluations retrospectively in specific populations. Being arrested or getting caught for something does not reveal the pathology or the correlation. You have to look for it.

And nothing is known of subpopulations of psychopaths and the impact of intelligence, education, profession and other factors and how they relate to outcomes and consequences over time. Egocentricity and a sense of entitlement drives they do not adapt to the environment but try to make the environment adapt to them. Without empathy and lacking remorse the goal is always self-serving and a question of what they can get out of it.

 Many judges, as an alternative to incarceration, have been requiring people arrested for drug and alcohol related offenses to attend AA meetings and provide proof of participation. As misguided as this is on other levels it is also dangerous. Given a choice between incarceration and attending AA the majority of any population, including those with psychopathic traits, would choose the latter. And as in any situation they would use it to see what they could get out of it. Masters of manipulation and impression management in a room full of potential victims. The reports of rape and theft coming out is no surprise. It is in all likelihood much worse.

And in reality psychopaths exist in every profession, including medicine.

What is the natural history and final common pathway of M.D. psychopaths?  Where do these shape-shifters end up?

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In his book Without Conscience, Dr. Robert Hare notes “If we can’t spot them, we are doomed to be their victims, both as individuals and as a society. ” Dr. Clive Boddy in Corporate Psychopaths observes that unethical leaders create unethical followers, which in turn create unethical companies and society suffers as a result.” And if you look at the FSPHP branch of the ASAM that is exactly what you will find.  less than 1/% of the population are psychopaths but they represent more that 10% of those in prisons.  What is the natural history of the physician psychopath? You do the math.

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http://psychopathyinfo.wordpress.com/2012/03/22/characteristics-of-corporate-psychopaths-and-their-corporations/


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Skipper

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

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

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

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

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

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

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

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

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

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

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

The American philosopher Eric Hoffer noted:

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

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

“Addiction Medicine” not a recognized medical specialty.

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

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

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

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

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

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

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

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

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

According to the FSPHP, physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years.”

The policy extends PHP authority to cover physical illnesses affecting cognitive, motor, or perceptive skills, disruptive physician behavior, and “process addiction” (compulsive gambling, compulsive spending, video gaming, and “workaholism”). It also defines “relapse without use” as “behavior without chemical use that is suggestive of impending relapse.”

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

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

The Need for Regulation, Oversight, and Accountability

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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