Reliability of hair drug tests up for debate

via Reliability of hair drug tests up for debate

The Birth of Junk-Science in Drug and Alcohol Testing

The attached article concerns the reliability of hair-strand tests routinely accepted in child welfare cases in Ontario   as evidence of parental drug or alcohol abuse.  A positive test can lead to loss of parental custody of children.

The risk for false-positive results appears to be higher in women because of the higher use of alcohol-based hair products and the limitations of these tests are addressed in the article.

Almost 98% of ingested alcohol is eliminated through the liver in an oxidation process that involves its conversion to acetaldehyde and acetic acid, but the remaining 2% is eliminated through the urine, sweat, or breath.1

Ethyl Glucuronide (EtG) was introduced in 1999 as a biomarker for alcohol consumption,2 and was subsequently suggested as a tool to monitor health professionals by Dr. Gregory Skipper, M.D.,  because of its high sensitivity to ethanol ingestion.3

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This minor metabolite of alcohol was reported by  Skipper, M.D. and Friedrich Wurst, M.D., in November 2002 at an international meeting of the American Medical Society, to provide proof of alcohol consumption as much as 5 days after drinking an alcoholic beverage, well after the alcohol itself had been eliminated from the body.

In his study Dr. Skipper arbitrarily chose a value of 100 as a cut-off for EtG. The rationale behind this value is not cited.

In 2003, because of these and other reportedly remarkable results (e.g., positive findings, confirmed by admissions by the tested individuals, after traditional urine tests had registered negative), Skipper pitched the test to National Medical Services, Inc. (NMS labs) and it was developed as a Laboratory Developed Test (LDT).

So began EtG testing began in the United States, and this paved the way for the hair tests described. The urine EtG test introduced by Skipper is the index case and prototype for an array of unproven forensic tests introduced to the market as LDTs.

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Against the Rising Tide: Looking for Biostatisticians and Epidemiologists to help shape Drug-Testing Policy to be more Evidence-Based

via Against the Rising Tide: Looking for Biostatisticians and Epidemiologists to help shape Drug-Testing Policy to be more Evidence-Based

Wanted!–a Few Honest Statisticians, Biostatisticans and Epidemiologists who want to make a difference..

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It is only a few public policy steps and minor changes in state regulatory statutes before what is described in the ASAM White Paper on Drug Testing comes to fruition.  Before we know it the Drug and Alcohol Testing Industries “New Paradigm” as described here by Robert Dupont will be ushered in.  From the ASAM white Paper:

“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.”
 

Backed by the multi-billion dollar drug and alcohol testing, assessment and treatment industry the public policy positions of the American Society of Addiction Medicine (ASAM) have invariably passed. There has been little if any meaningful opposition.

To prevent this future drug testing dystopia, that includes testing schoolchildren, we need to take a step back and analyze the reliability and credibility of the “evidence-base” behind these multiple non-FDA approved (Introduced as Laboratory Developed Tests (LDTs) to bypass FDA approval) “forensic” drug and alcohol tests and testing devices (The alcohol biomarkers EtG, EtS, PEth; SCRAM (Subcutaneous Remote Alcohol Monitoring Bracelet);CDPB (Cellular Digital Photo Breathalyzer); and Hair Testing- Psychemedics, etc.) the ASAM proposes be used on the population at large.  These tests include nail, hair, saliva, breath, blood and urine and they plan on utilizing the Medical Profession as a urine collection agency by calling this testing a “medical evaluation” rather than “monitoring” for drug and alcohol use.   This change in semantics enables them to bypass the usual forensic drug testing protocol (that includes strict chain-of-custody collection and MRO review) designed to minimize false-positives because the results of erroneous test can be grave and far reaching.  According to the ASAM white paper the “clinical” collection of specimens as is good enough as the results of a positive test will result in “treatment” rather than “punishment.”

Amazingly, there has been no Academic review of these tests, let alone a Cochrane type critical analysis.  It is essentially untapped territory.  In addition there has been no Institute of Medicine type Conflict of Interest Analysis.  

Sinclair Lewis’ “Elmer Gantry” and the “physician wellness” crusade.

via Sinclair Lewis’ “Elmer Gantry” and the “physician wellness” crusade.

Sinclair Lewis’ 1927 novel Elmer Gantry is a satire on fundamentalist  religion in 1920s America. The eponymous character is  a greedy and debauched womanizer  who reinvents himself as an evangelical minister. The Reverend Dr. Elmer Gantry is a carney huckster who weasels himself into becoming the leader of a large Methodist congregation.   He organizes crusades against immorality while he himself is amoral. Gantry is an unethical and unprincipled power hungry narcissist who contributes to the downfall, injury and even death of those around him.  Lewis’ portrayal of pious hypocrisy and opportunism of fanatical religiosity was denounced from pulpits across the country.  The book was banned in Boston and many other cities with official censorship boards.    Public libraries and some booksellers refused to stock it and the author was threatened with litigation, jail, injury and even death.  The attempts at censorship backfired and the novel quickly went to number one on the fiction bestseller list.

The “religion racket” no longer has the power to determine what we read.  Unfortunately, similar groups have gained tremendous sway.  The “rehab racket” has erected a scaffold able to remove our constitutionally protected rights and civil liberties not only legally but under the pretense of doing so out of our own best interests.      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.

This system has unfortunately given power and allowances to unethical individuals  who are able to exert control over other individuals under the guise of “treatment” regardless of whether or not those individuals even need it as inherent in the current chronic brain disease model of addiction is the importance of external control.

 

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“There are risks and costs to action. But they are far less than the long range risks of comfortable inaction”- John F. Kennedy

via “There are risks and costs to action. But they are far less than the long range risks of comfortable inaction”- John F. Kennedy

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“There are risks and costs to action. But they are far less than the long range risks of comfortable inaction”- John F. Kennedy

Born – May 29, 1917
Brookline, Massachusetts,
Died- November 22, 1963
Dallas, Texas, aged 46

“A man does what he must–in spite of personal consequences, in spite of obstacles and dangers and pressures–and that is the basis of all human morality.”–JFK

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“One of the saddest lessons of history is this..”–Carl Sagan

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Disrupted Physician

“One of the saddest lessons of history is this: If we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. The bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken. Once you give a charlatan power over you, you almost never get it back.”

― Carl Sagan, The Demon-Haunted World: Science as a Candle in the Dark

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“One of the sad…

“One of the saddest lessons of history is this: If we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. The bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken. Once you give a charlatan power over you, you almost never get it back.”

― Carl Sagan, The Demon-Haunted World: Science as a Candle in the Dark