Although my challenge to reveal his true identity in “Rantings from the Bully Pulpit” remains unaddressed, the doctor known as “TT Wilson” has put his two cents in on a couple of issues over the past month. I previously posted his comments to illustrate the groupthink and common tactics of doctors involved in state Physician Health Programs (PHPs) and Drug Courts. Wilson’s comments are pathognomonic of these groups and his new comments are chock full of humdingers that reinforce my notion of Wilson’s LMD affiliation. .Although Wilson never answered any of my questions his apparently piqued curiosity prompted him to query some my way.
The question is whether or not I would revise my posts concerning the legitimacy of addiction medicine when it is “embraced by the ABMS (American Board of Medical Specialties) in two years.” My answer is no.
ABMS accepting addiction medicine into the fold is not a product of the discipline meeting the collectively identified standards set by ABMS but a product of ABMS altering its standards to let addiction medicine in through the back door. I do not know the specifics yet but if history is any indicator I would guess it to be a mixture of loopholes, workarounds and cash leverage.
The current addiction medicine paradigm is not built on the scientific method or evidence base but a foundation built on shortcuts, manipulation of public policy, bent science, flawed and biased research and tinkering with the machinery of regulatory and administrative law. My criticisms are based on specific and easily documentable examples of which there are many. ABMS giving addiction medicine a thumbs up does not change any of that It is analogous to the Federation of State Medical Boards approving EtG for alcohol monitoring. The validity of EtG did not go up when the FSMB approved it. Valid criticisms are valid criticisms. Unfortunately ABMS certification will facilitate a bigger net for addiction medicine specialists schooled in one uncompromising model of addiction and treatment. The inevitable result will be more deaths due to a one size fits all abstinence based treatment paradigm necessitating zero-tolerance for alcohol and drugs but utilizing junk-science drug and alcohol testing of unknown validity–a recipe for suicide as is being seen in doctors will be played out on a larger scale. Teenagers being teenagers will be forced into a revolving door of testing, treatment and lifelong abstinence and many will end up dying. Don’t get me wrong —teenagers with real drug and alcohol problems need treatment but, as was seen in Straight, Inc., a large number of those coerced into abusive programs for treatment were there because they experimented with drugs and in all likelihood were engaging in behavior that would have stopped on its own accord as they matured. Unfortunately, many were not given that opportunity.
If I am interpreting the next topic correctly Wilson seems to be advocating we do away with the trouble of internship and residency training and that specialty certification be obtained by simply taking a test. (how addiction medicine does it now). Hey why not take it even further-we’ve all got computers these days so why not dispense with medical school too and earn your degree from home.
This pattern of softening the rigors and minimizing the importance of knowledge and experience is a concerning theme however. The ASAM White paper argues that the use of MROs for forensic drug and alcohol testing is unnecessary.
Interesting thought but internships, residencies and fellowships exist for a reason–apprenticeship, knowledge and experience.
Wilson then points out the ABIM MOC debacle –another common tactic this group utilizes when confronted with criticism—pointing the finger and deflecting the criticisms to another group to avoid a direct answer. His reference to my blog as a “rant” and “rage” is per PHP script. Deeming criticisms as rants and rages is intended to minimize and invalidate them and avoid a direct answer. Critics are frequently diagnosed with “resentment” and “unresolved issues” no matter what the validity of the criticisms.
TT Wilson then states ABMS approval of addiction medicine as a specialty necessitates I “rage” against ABMS and not doing so would be inconsistent. The logic is similar to the false-dichotomies and either or fallacies frequently used such as brain disease and moral failing, Abstinence and relapse, and other areas where they completely exclude the middle. Consistency of my comments would require I comment ABMS acceptance was the result of backdoor dealings and a mistake but that is the extent of it. Wilson then expresses his anticipation of delight believing ABMS sanctification will somehow stupefy me into some sort of fugue or dumbfounded disbelief as ABMS legitimizes addiction medicine. I don’t know what expectations are in providing him the great fun and endless amusement he mentions of in anticipatory schadenfreude but in reading his comment I was picturing him rubbing his hands together and grinning ear to ear.
Logical fallacies, false dichotomies and a bag of tricks and tropes with no substantive value but that appeal to the intended audience are all part of the PHP playbook. A torrent of rodomontade including appeals to the authorities creeds and values. .–“promoting a culture of safety..,” “in the interests of Professionalism” and “protecting the public good..” are always part of the preface. Boosterism and puffery to rally the troops. A problem is then created by identifying a threat using exaggerated rhetoric and fear monitoring to instill anxiety and inspire a moral panic. “Something must be done.” The public good has been assailed. Exude authority and respectability and offer assistance using special knowledge to address the threat and make the audience feel good by describing an auspicious and improved future.
Feel Good Fallacies
“Feel good fallacies” are used to frame positions in a way that makes people feel good about supporting certain policies even when scientific evidence shows there is no need for them. TT Wilsons comment that “communities see how well run addiction programs save lives and force crime away from their homes” in reference to drug courts is characteristic of “feel good fallacies” and one of many tactics used to misrepresent, censor, suppress, mislead, ignore, marginalize or bury the truth.
TT Wilson delivers another classic “feel good fallacy” in his response to Dr. Jonathan Roop’s brave and heartfelt letter detailing the injustices and abuses he suffered under the heavy boot of the Washington state PHP. Comments concerning the substantive and serious issues he described were invariably of concern and support. TT Wilson, however sidesteps the specific issues described by Dr. Roop and gives a happy ending anecdote about a drunk doctor who was saved by the PHP and successfully restored to work gainfully employed, healthy and sober. TT Wilson asks Roop how this case should have been handled and this “feel good fallacy” is a hallmark of PHPs who use these anecdotes to promote the “new paradigm” of PHPs as “gold standard” treatment. The question TT Wilson asks is rhetorical and consistent with the PHP template of
A) Ignore, marginalize or bury criticisms and complaints.
B) Boast How great these programs are in saving lives and protecting the public.
Complaints are successfully deflected,and marginalized no matter how valid or how substantive or serious the deviation from standard of care, ethical breach or legality. Often the victim is blamed and complaints such as Dr. Roops are deemed delusions or fabrications, the product of an impaired physicians sick mind or a manifestation of denial. In fact, this was the official response to Knight and Boyd’s paper concerning ethical and managerial problems with PHPs. In response to the specific and substantive issues Knight and Boyd describe and a call for outside oversight and regulation of PHPs ASAM President Stu Gitlow published an editorial basically saying there was no need for regulation or oversight because, guess what?–we have an 80% recovery rate. Can’t argue with success!
Well, actually you can. The 80% recovery rate being boasted is based on the “PHP blueprint” that is being used to claim PHPs are the “gold standard” and “new paradigm” to promote expansion of the PHP model to other populations. It is their flagship product and claim to fame and used as a promotional tool.
Just curious, but once addiction medicine is embraced by the ABMS in two years will you revise your posts? Frankly if they opened many of our boards to anyone who cared to take them a remarkable number of bright people would pass them without the rigor of residency or indignation of internships. I suspect that the powers that be know this hence the long and painful vetting process that goes on before one is deemed ‘board eligible’, a term that had stood for decades, then was deemed out of existence for a few years but now is back without much fanfare. And who put the ABMS in charge of anything? Why, they did that themselves. Funny how that works for some groups but is not appropriate for others. Oh well, all of this will be moot in a couple of years. Any comments about how the ABIM folded on their highly ordained MOC policies? Now that’s a story.
So when the ABMS recognizes the ABAM will you rage against them? Any sense of consistency would demand something like that. I can’t wait, it will be great fun to watch. Endless amusement. Thanks!!
The three e-mails below were received within a twenty-four hour period from a physician supporting (and in all likelihood involved in) drug courts and physician health programs (PHPs). E-mails such as this are invariably anonymous and I usually drag them right to the trash where they belong but the trio below provides valuable insight into the mentality of those involved. And for that reason I am posting them as they were received.
He presents either/or logical fallacy and false dichotomy. You are either with us or against us! He appeals to professionalism yet his words show he has no inkling of the true definition, resorts to simple-minded cliches and meaningless platitudes and then sinks into ad hominem attacks on my blog and then me.
Ironically he accuses me me of ranting in a rant!
He is a prototypical example of the sham-artist physicians typically involved in these programs–an authoritarian paternalistic know-it-all who can only rant under the shield of gang-stalking power or a shroud of absolute anonymity.
As I have said time-and-time again if any factual errors exist in my blog I will not only remove them but remove my blog.
So I am going to make this offer to “TT Wilson”–if you wish to provide a rebuttal of any of the documentary evidence I provide in my blog herein then do so now. If you can I will delete the whole kit and kaboodle. Simple as that.
You Sir are an incompetent and a coward. If not then prove me wrong. I challenge you to reveal your true identity. Let’s level the playing field a tad on this. It is easy to present an opinion while cowardly hiding behind a veil of anonymity. Let’s see if you have the courage to debate this publicly.
I won’t be holding my breath on this one.
February 7, 2015 7:45 PM
Comment: It looks like it is too late already. The ABAM is closer than ever to becoming a member of the ABMS, there is a big push from the Obama administration to fund addiction treatment and to greatly widen access. As communities see how well run addiction programs save lives and force crime away from their homes the trend will be very hard to stop. I agree, PHPs are draconian when they work with physicians thought to have SUDs, but I would rather have them too tough than too lax. And a sober physician should be OK with that.
February 7, 2015 3:00 PM
Comment: Actually well run drug courts help patients who would have otherwise kept using substances of abuse. Drug courts are quite dictatorial by design and clearly a defiant patient will defeat even the most caring and competent efforts to help them. Of course we prefer that the patients be in a stage of change that leaves them open to treatment, but more than a few we’ve helped were not about to change without pressure from the court.
And I stipulated well run drug courts. There are many incredibly poorly run drug courts. When a judge doesn’t get it things are just as bad or worse than when the medical team doesn’t get it. And the studies done are typically dismal. Very short, small sample size, no standardization.
As far as impaired physicians are concerned, it is not enough to just stop using and declare innocence. If a cardinal event has attracted the attention of the medial (sic) board and that board requires participation in treatment to maintain licensure, well that goes with the license. You can certainly choose not to participate, and the board can then choose to not let you practice. They do the same thing with physicians with psychiatric issues. And they encounter a huge amount of denial in this population, I would say more so than the lay population. At least the denial is louder.
Dictatorial — sure. Fair — well, no. But life is not fair.
As doctors we owe it to our patients to be held to a higher standard. If someone of authority says I need to be screened, they are most welcome to any fluid or hair sample they require. Is that fair? Surely not. Does that make it bad? Not at all.
Do you have a better approach? So far you haven’t demonstrated it in your myriad postings.
As far as ABAM is concerned, have you cried out about the ER boards, Pain Medicine boards, and all of the other boards that have been added to the charter members of the ABMS over the years? Heck, back in the day a buddy of mine was grandfathered into the board of Plastic Surgery without even taking a test. He sent them $500 and he was board certified. Got a really nice certificate too, but it didn’t come with a frame. Years later they started requiring fellowship training and actually taking a test.
I enjoy your site — clearly there are problems with the way care is being delivered by some individuals in some cases. Of course that is true of every aspect of medicine. No one is advocating that we shut down every other aspect of medicine. Well some are, but that is for another discussion.
My concern is that your ranting will deter some people away from meaningful treatment, very much like those who seethe against vaccinations lead the unknowing to not treat their children. If I was cynical I could invoke Darwin here. Thinning the herd.
And you might want to get some help with wordpress. This endless scrolling is distracting. I was missing a good third of your content.
February 7. 2015 9:45 PM
Comment: Finally made it to your last entry. Please learn how to conduct a wordpress blog — your technique is very distracting.
You protesteth too much good sir. Put aside your denial and get some treatment. I am sure Harvard was glad to be rid of you. They are very lucky you are out of there.
There might be some legitimate content in there somewhere, but by the time I reached the bottom of the page I was ready to hand you a mood disorder questionaire. Not that we really need you to fill one out to make a diagnosis.