Medical Students and Physician Health Programs–A Modest Proposal to Medical School Administrators to Prevent a Potentially Impairing Catastrophe

screen-shot-2016-03-10-at-10-17-17-pmIt is hard to imagine a more stupid or more dangerous way of making decisions than by putting those decisions in the hands of people who pay no price for being wrong. 
-Thomas Sowell

I have been contacted by multiple medical students since my post concerning state physician health programs (PHPs) targeting medical students. These students have reported similar stories of coercion into unneeded treatment under the threat of being pulled from medical school.  They were told either comply with the demands of the PHP or you will not be coming back next semester.

Potentially Impairing Diagnosis

One concerning pattern that is emerging in these reports are students that are being referred to these programs not because of any specific concern or precipitant event, but because of a past diagnosis or existing long-term diagnosis that has been stable under treatment by qualified professionals.  Two students who contacted me have had ADHD since high school under control with legitimately prescribed Adderall , two had histories of depression long resolved and another  was being treated for depression with a legitimately prescribed anti-depressant.   These students were in the dark as to why they were being referred to the PHP, knew nothing about PHPs and had no idea any adverse consequences were a possibility.  They initially thought this was some sort of student health type wellness “check-in” where they would just touch base for reassurances regarding proper diagnosis and treatment and that would be the end of it.   Such  was not the case as things took a nasty left-turn for them once they met with the PHP.  Each was referred for out-of-state evaluations. Each was given a diagnosis with recommendations for inpatient treatment.   Each was told by their medical schools that if they did not comply with recommended inpatient treatment they would be pulled out of school the following semester and not be coming back.  Each has met a dead end negotiating with their schools. Only one student is capable of getting the money to complete the recommended treatment  which is out-of-pocket and not covered by insurance (60-80 thousand dollars on average).screen-shot-2015-04-03-at-2-48-33-am

How did this occur?  The inpatient evaluation centers justified their treatment recommendations by questioning the stability of their diagnoses and expressed concerns about possible underlying issues potentially precipitating future impairment. The conclusions were that they would “benefit from treatment” and that the evaluators “could not advocate” it would be safe for them to continue medical school because of their “potentially impairing illness” and the possibility of future patient harm. Of course substance abuse issues were also raised as both students with ADHD were given diagnoses of “Amphetamine Use Disorder” and two others were given a diagnosis of possible “Alcohol Use Disorder.” The latter was based entirely on a positive PEth (Phosphatidyl-ethanol) biomarker (a test introduced and promoted by physicians involved in state physician health programs.

What boggles the mind is that these students all provided letters from their treatment providers and obtained independent and comprehensive evaluations from outside experts contradicting the diagnoses and disavowing inpatient treatment as well as collateral support letters.  None of it was acknowledged let alone addressed.  Two students asked why they needed inpatient treatment when they had expert opinions deeming it unneeded and they were fine.

“Because they are the experts.”

Now the assumption of omniscience,  blind faith and the spirit of authoritarianism are unacceptable mindsets in academic medicine.  The validity and reliability of opinions lie in their underlying methodology and evidence base. Reliance on the personal authority of any expert or group of experts is the fallacy of appeal to authority.  Social and academic responsibility demand investigation and questioning when contradictory evidence is presented especially when the consequences can be permanent.  The American philosopher and feminist theorist Marilyn Frye defined oppression as “a system of interrelated forces and barriers which reduce, immobilize and mold people who belong to a certain group, and effect their subordination to another group.”  Individuals in academia should play not be willing participants in a system of institutional injustice and the role of detached bystander giving full deference and allowances to these pious wolves is no different than being a willing henchman.  The result is the same. screen-shot-2015-03-25-at-9-01-24-pm

It appears the  Federation of State Physician Health Programs (FSPHP) has used the same tactics with academic administrators as they have with regulatory and hospital administrators. They have convinced them to not question their methods or motives lest it “undermine a culture of professionalism.” They have done this by claiming.

  1. We are the experts. We are benevolent. We are here to help.
  2. Leave it all up to us.  No worries. Referral  is the first step so do not burden yourselves with preliminary investigations of board disciplinary meetings.  We will do all the work and take the burden off of the administration.  No more in-house review.
  3. By the way questioning our authority undermines our authority.  We are the experts and we are doing all the work. We should make this official by written policy and procedure. No questioning our diagnoses.

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


Unexamined, Illegitimate and Irrational Authority

It is important to recognize that the Federation of State Physician Health Programs (FSPHP)  has been making authoritative pronouncements on physician health issues as unexamined authority since 1990. Over the past 25-years they have influenced a large body of practice and policy with no meaningful opposition. It only takes a modicum of investigative research to reveal each specific practice, each legal, regulatory and healthcare policy the pushed and each position they took on the issues.  It is simple to identify the what, when and why on all of it.  One invaluable resource is the The Journal of Medical Regulation  archives which is the official publication of the Federation of State Medical Boards.  It has been fully archived online with every issue in chronological order containing full articles.  An index related to all practice and policy pushed by the FSPHP is easily generated by putting in keywords related to physician impairment.

screen-shot-2016-12-08-at-3-34-23-pmOnce practice and policy is identified a risk/benefit type analysis can be done on each and this is a rather simple matter as the issues are fairly black and white.  Statistics is not needed-just common sense and logic.   What one will find is that the practice and policy promoted by the FSPHP has not in the best interests of doctors or society but in the best interests of the FSPHP and the drug and alcohol testing and treatment industry .  In short, the individual practices and policies have provided physician health programs with more power and protection while incrementally removing the fundamental rights and due process protections of doctors with the end result being not only control of their professional behavior but their private lives.  To benefit the drug and alcohol testing and treatment and treatment industry they have pushed a plethora of bad ideas including introducing junk-science for forensic drug testing and limiting physician evaluations to only “PHP-approved” assessment and treatment centers.   A public policy analysis is long overdue.   So too is a conflict of interest analysis and a critical analysis of the”research” which consists of two categories; 1. Research showing that shows the high success rates and benefits of PHPs 2. Research on laboratory developed tests (LDTs) and other dubious testing methodology they have introduced (such as non-validated neuropsychological testing for diagnosing disruptive physicians) and promoted    (including polygraphs which is unbelievable since AMA policy discounts them as a game of chance.).   All practice and policy that has been pushed by the FSPHP was accepted by the FSMB (and others) without question or concern.   It has all  been done with no meaningful opposition.

It was not until 2012 that anyone stood up and challenged their policy and practice.  In 2012 John Knight, M.D. and J. Wesley Boyd, M.D., PhD published a Journal of Addiction Medicine article entitled Ethical and Managerial Considerations Regarding State Physician Health Programs and they state:

Because PHP practices are unknown to most physicians before becoming a client of the PHP, many PHPs operate out- side the scrutiny of the medical community at large. Physicians referred to PHPs are often compromised to some degree, have very little power, and are, therefore, not in a position to voice what might be legitimate objections to a PHP’s practices.”

screen-shot-2015-11-17-at-11-00-44-pmHighlighting the  significant financial conflicts-of-interest between PHPs and their preferred assessment the authors add:

“..if the PHP highlights a physician as particularly problematic, the evaluation center might—whether consciously or otherwisetailor its diagnoses and recommendations in a way that will support the PHP’s impression of that physician.”

As any first-year  medical student knows a “diagnosis” is derived from signs and symptoms. It is something that is arrived at. It cannot be “tailored” like a suit.  It represents diagnosis rigging and fraud. And as the “recommendations” inevitably amount to inpatient treatment this equates with the political abuse of psychiatry.   This paper generated little interest.  Just as facts, evidence and reason are drowned out under the all encompassing misappropriation of the term “denial” the serious allegations of Knight and Boyd were drowned out under the bogus claim of the successful outcomes of these programs.

Emerging and Emergent Concerns of Diagnosis Rigging and Fraud

 Pauline Anderson’s  Physician Health Programs: More Harm Than Good? has recently opened the door to exposing the financial exploitation and abuse of doctors by state physician health programs (PHPs) and their preferred drug and alcohol testing and treatment facilities. The August 2015 Medscape News article was the first mainstream medical publication to specifically address the coercive tactics of these programs and the dearth of oversight and accountability.

screen-shot-2016-09-30-at-1-31-17-pmIn her  rebuttal  to Medscape Medical News  FSPHP President Doris Gunderson claims that PHPs do indeed have oversight. She states:

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

This statement is untrue.  Accountability requires both the provision of information and justification for actions to a a truly independent outside agent capable of providing sanctions for misconduct. This requires an outside independent organization with both investigatory and disciplinary authority. No such agency exists for these programs. Multiple articles questioning these programs integrity and intent have come out since this time such as “Physician health programs under fire”  published in the British Medical Journal (BMJ) and written by  BMJ editor Jeanne Lenzer.  None received any meaningful response.  The fact that the President of the FSPHP responded to the BMJ with logical fallacy and half-truths is concerning.  Another past president of the FSPHP who was the medical director of the North Carolina PHP was unable to identify what qualitative indicators and quantitative measurements went into “approving” the “PHP-approved” facilities.  The only response he could give was reputation and word of mouth.  He could not provide any criteria. and did not plausibly answer the question.The audit of the NC PHP can be found here.  Documentation that another past president of the FSPHP is involved in forensic fraud and fabrication of evidence is precise and clear.  It is indefensible.  These are all past presidents of the FSPHP and their inability to provide direct and simple answers to direct and simple questions is inexcusable.


Removal of Due Process Through “Medicalization”

Physician health programs (PHPs) are viewed as facilitating “treatment” not “punishment” and are analogous to criminal justice system policy aimed at solving social problems by obtaining individual compliance to a given social structure.  Given the assumption that these programs are providing help to those suffering from a substance use or psychiatric disorder provides great political leverage with decision makers. Given that these same organizations have actively stoked the politics of fear by creating the mythology of  a hidden cadre of drug addled and disruptive doctors posing a danger to patients removes any possible thread of lifeline for the accused.  The mere accusation of substance abuse or behavioral deviance is used to disregard the claims of the accused. 

images-31-copyMedicalization removes the constitutional safeguards of due process.   The potential for abuse is especially the case in the absence of clearly articulated and openly established program policies and procedures.

The Urgent Need for a “Counterpower”

It is critical to create some type of  due process or redress for putative impaired medical students who are the objects of state physician health program therapeutic interventions. At present there is no “counterpower” to PHP control.  This could take the form of an advocacy group or intervention review organization with the goal of ensuring the veracity of both the claims and purported diagnosis and make certain that individual rights were not circumvented in the name of “help.” Although it is difficult to stand up to”authority” and not “make waves” it is essential to do so as soon as possible.

Students monitored under the current paradigm find themselves straining at a dual leash. The obstacles that are  thrown in their paths by the physician health rabble are as onerous as they are unnecessary. It is essential that some sort of appeals and support process be implemented as this situation is corrected.   Social and academic responsibilities always demand the scholarly search for truth and the correction of error.  Give some allowances while this sorts itself out.

Mark Twain said that it is “easier to fool people then to convince them that they have been fooled.”  The ease of this task is undoubtedly inversely proportional to the complexity and scope of the bamboozle. The current physician health paradigm rests on a  “Big Lie” which can be defined as something repeated loud enough and often enough that it drowns out all opposing viewpoints.  The “Big Lie” here was the proposition that doctors are different and doctors are dangerous.  A scaffold of false claims creating a false -construct has been built upon the “Big Lie” –it is a constructed reality that is false.  It is a house of cards that is easily debunked.   All it will take to do this is the interest and the will to do so.

A Modest Proposal-Facts Matter and a Diagnosis is Derived from Signs and Symptoms-It Cannot be “Tailored”

screen-shot-2016-09-30-at-1-30-53-pm In the interim I propose the following.  It would not be that difficult to set up a second opinion through medical schools involving an anonymous group of their own experts.  The reason for this  anonymity is self-evident. The primary reason other doctors do not speak up against these programs is the fear of being targeted themselves.  Allowing physician health programs carte blanche authority is bad policy and being bamboozled into accepting this group as unquestioned expert authority is a fools game.  Providing independent evaluation is a simple task and if the independent evaluation concludes there is no problem then rest assured there is no problem.

One of the saddest aspects of this is the damage done to society by the injury inflicted on otherwise capable and brilliant students whose careers are being snuffed out by charlatans and fools.



Read More Below (Prior Post)

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


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

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

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

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

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

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

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

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

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

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

Diagnosing disease without meeting the diagnostic criteria for that disease.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Medical school drug testing is a moral and scientific failure

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

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

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

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

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

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

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

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

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

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

The author is an anonymous medical student who blogs at unchainedmedical.

14 thoughts on “Medical Students and Physician Health Programs–A Modest Proposal to Medical School Administrators to Prevent a Potentially Impairing Catastrophe

  1. This is a travesty. I have had my own personal experience with the PHP as well as working for a ” Physician Approved, treatment center, Promises in southern California. The evaluations, are 4500 bucks that are ‘ applied to the cost of treatment’ because treatment is always recommended. If a physician balks st the diagnosis, this simply affirms the diagnosis in the eyes of the PHP as ” denial” is pervasive in addiction. What a crock. Your findings are absolutely correct.


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