A Golden Age

BY TIMOTHY STEELE

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

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

Source: Sapphics Against Anger and Other Poems (1986)

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Disappointed that his grandiose proposal to test the urine of half the U.S. population for illicit drugs was declined in the 1980’s, Bob realizes such a large swath was too tall an order. Acknowledging that his dream of lifelong urine drops for each and every one of the riffraff at least once a fortnight will take time, he decides to focus his attention on specific subsets of the great unwashed such as school-children, welfare mothers, the unemployed and whatever they are calling Hippies these days.
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Medical Urban Legend–The Legacy of the 4 MDs and why B.S. Needs to be Identified from the Get-Go!

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

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

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

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

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

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

Arrogance or Self-confidence?

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

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

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

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

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

Doctors Are Harried and Pressured; Patients Are More Demanding

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

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

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

Is There an Outbreak of Rudeness?

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

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

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

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

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

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

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

Medscape Business of Medicine © 2014 WebMD, LLC

The Addiction Medicine Control Machine

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

 

 

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

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

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

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

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

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

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

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

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

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

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

“With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world.”-Twelve Steps and Twelve Traditions, AA World Services, Inc (1953).

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

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

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