This is an Important Public Service Announcement (PSA): Physician health programs (PHPs) are not causing physician suicides: Illegitimate authority is.

Illegitimate power and abusive authority cannot be bargained with.  They must be called out and removed.  As one of my personal hero’s Dietrich Bonhoeffer said:

“We are not to simply bandage the wounds of victims beneath the wheels of injustice, we are to drive a spoke into the wheel itself.”

So here is the deal–I want to keep this up and I want to keep doing this.  I have gotten this far but without your help but it all vanishes very soon and a lot of other bad things are going to happen. So if you have enjoyed reading my blog, or if I have ever helped you in the past or if you want to help remove this illegitimate power currently controlling the profession of medicine and help me finish what I started then please contribute! The link is below:

This is an Important Public Service Announcement (PSA): Physician health programs (PHPs) are not causing physician suicides: Illegitimate authority is.

Please Donate to Fund Below

So here is the deal–I want to keep this up and I want to keep doing this.  I have gotten this far but without your help but it all vanishes in 6-days. So if you have enjoyed reading my blog, or if I have ever helped you in the past or if you want to help remove this illegitimate power currently controlling the profession of medicine and help me finish what I started then forGod’s sake please help me out here.!


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First post on disrupted October 22, 2014

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She likes a rigged game, you know what I mean?”
— R.P. Murphy in Ken Kesey’s One Flew Over the Cuckoo’s Nest

Published  in the March 17, 2014 newsletter Alcoholism and Drug Abuse Weekly, an article  entitled “Physician group urges focus on spiritual and psychosocial” describes a group of doctors who “emphasize that for all addictions, the psychosocial and spiritual interventions, including 12-step interventions must be included in the treatment process and,” according to founding board member Dr. Ken Thompson, M.D., “to not do so falls short of practicing good addiction medicine.”

With a “significant percentage” in 12-step recovery themselves, “they have formed a  group called “Like-Minded Docs,which has more than 150 physicians, many of whom are medical directors of top treatment programs and also members of the American Society of Addiction Medicine (ASAM).” Dr. Thompson is in fact the Medical Director of Caron treatment center in Pennsylvania. The group also includes the medical directors of Hazelden, Talbott, Marworth, Promises, and other assessment and treatment centers used by state regulatory agencies to evaluate and treat referred physicians.    The President of the American Society of Addiction Medicine is a Like-Minded Doc as is former White House Drug Czar (1973-1977) Robert Dupont. In addition, the physician who introduced the long-term alcohol biomarkers Ethyl-glucuronide (EtG),  Ethyl-sulfate (EtS), and Phosphatidylethanol (PEth) is a like-Minded Doc as is  Wayne Gavryck, The Medical Review Officer for the Massachusetts Physician Health Program PHS, Inc.  How does he reconcile his 12-step belief system with fraud and misconduct?   It is either doublethink or the A.A. spirituality persona is just a front.

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Although I  applaud the ideal of addressing the psychosocial and spiritual aspects of addiction and acknowledge that 12-step recovery is a treatment tool that can provide great benefit to some people, I do believe there is an inherent conflict-of-interest here. Having no strong feelings for or against A.A, I  view it through the same pluralistic and open-minded lens as I do religion or philosophy;  there are many paths to salvation and none superior. I have referred patients to A.A. myself  and see it as an option and a personal choice, one tool in the toolbox  that can provide great benefit to some people, do absolutely nothing for others and, in fact, harm some.   If it works for you good for you. Knock yourself out.  If not then let’s try something different.

So although the ideals of Like-Minded Docs are ostensibly laudable, the framework is not necessarily so.  What is  most concerning is a confluence of currents that preclude option and choice. It is a scaffold that can be used for coercion, control, and imposition. And this is exactly what is being done in many of the State Physician Health Programs (PHPs).

Originally funded by state medical societies and staffed by volunteer physicians, PHP’s were designed to help sick doctors and protect the public. But over the past decade these programs have undergone a sweeping transformation due to the influence of the American Society of Addiction Medicine (ASAM). Unlike Addiction Psychiatry, ASAM is not recognized by the American Board of Medical Specialties (ABMS). They created their own “board certification” (ABAM)  in 1986 and most physicians do not know that the only requirement is an M.D. in ANY specialty and some sort of experience in substance abuse.

Trumpeting the false dichotomy that addiction is a “brain disease” and not a “moral failing” while portraying themselves as altruistic advocates of the afflicted, the ASAM has cultivated an organization that exudes authority, knowledge, respectability, and advocacy. They have set forth definitions of addiction, shaped diagnostic criteria, dictated assessment protocols, and shaped public policy all under the guise of scholarship and compassion.

They introduced junk science such as the EtG and PEth alcohol biomarkers through Greg Skipper, FSPHP, ASAM, and another Like-Minded Doc.

They created the “moral panic” of a hidden cadre of drug addled and besotted doctors protected by a “culture of silence” disguised as some of the best workers in the hospital and in fact look “just like us.”  They introduced and promulgated the nebulous “disruptive physician” and successfully fostered a moral crusade to attack this huge hidden threat. And if you do a little searching you will find that their  next target is the “aging physician,”  demented doctors causing unseen mayhem and assailing the public good.  They are now  fomenting a call to arms to root out senility in medicine. It is the same tactic they used in the substance abusing and disruptive physician.  Social entrepreneurs.  Moral panic. Moral crusade.   With no evidence base and the use of  propaganda and disinformation they have convinced regulatory and administrative medicine that witches are real, witches are evil,  and they are the authority when it comes to witches and know how to identify and root them out with our witchpricking instruments.  And you know what?. It worked.

And by infiltrating state PHPs they have become the might and main of addiction medicine in the United States. By removing dissenters who disagreed with the groupthink they have taken over most of the state PHPs and organized under the Federation of State Physician Health Programs (FSPHP).

And the State PHPs under the FSPHP are very strict when it comes to choice in rehabilitation facilities for for physicians in need of assessments for substance abuse. In fact there is usually no choice in the matter.  The physician may be given a choice of facilities but that is a ruse as it is a false choice– smoke and mirrors sleight of hand. Deception.

As home to some of the countries top ranked hospitals and most prestigious medical schools Massachusetts is an international healthcare hub with world-class teaching, research, and clinical care. Two of the top three psychiatric hospitals in the United States as rated by U.S. News and World Report are found here in Massachusetts with McLean Hospital earning the top prize and Massachusetts General Hospital ranked number three. However, this medical mecca of learning and research is apparently unable to attract anyone with the competence and skill to assess a physician for addiction or substance abuse.

In Massachusetts if the State PHP, PHS,inc. feels a physician is in need of an assessment the evaluation must be done at “a facility experienced in the assessment and treatment of health care professionals.”  No exceptions. And apparently these esoteric skills are only found in Georgia, Arkansas, Alabama, Kansas, and a half dozen other far-away places.

With over 20 years experience with the Massachusetts PHP, Physicians Health Services, inc., Harvard Medical Schools Dr.’s John Knight and J. Wesley Boyd published an article in the Journal of Addiction Medicine last year concerning Ethical and Managerial Considerations Regarding State Physician Health Programs.

One of the issues they discussed was the conflicts of interest between the state PHPs and the evaluation centers. One comment I was surprised got past editorial review was that the treatment centers may “consciously or otherwise” tailor diagnosis and recommendations to the PHP’s impression of that physician. “consciously” tailoring a diagnosis is fraud. It is political abuse of psychiatry. It is unethical. It is, in fact, a crime.

If you cross-reference the  medical directors of the “PHP-preferred facilities”  with the list of LMD’s it is a perfect match.

Therefore when the PHP refers a physician for an evaluation and gives them a choice of an assessment facility there is no choice. It is three card monte. A shell game. Heads I win tails you lose.



The ASAM has imposed the prohibitionist chronic brain disease spiritual recovery model of addiction on the field of medicine. It is a system of coercion, control, and indoctrination. And another ASAM Like-Minded Doc, Robert Dupont, is calling this the “new paradigm” of addiction medicine and wants to spread it out to other venues including schools.

Like-Minded Docs solves the final piece of the puzzle. It explains why so many doctors across the country are claiming fabrication and manipulation of personality and cognitive tests to support nonexistent diagnoses. In evaluating a physician this group is not gathering data to form a hypothesis but making data fit a hypothesis that arrived well before the physician did.  And this may be part of the explanation for the recent marked increase in physician suicide. With guilt assumed from the start, no due process, no appeal, and no way out physicians are being bullied, demoralized, and dehumanized  to the point of hopelessness. This needs to end now.


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

Disrupted Physician


“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)


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…

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“As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.”– Thanksgiving Day Proclamation 1963—John F. Kennedy

“As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.”– Thanksgiving Day Proclamation 1963—John F. Kennedy.


Let us therefore proclaim our gratitude to Providence for manifold blessings–let us be humbly thankful for inherited ideals–and let us resolve to share those blessings and those ideals with our fellow human beings throughout the world.

On that(this) day let us gather in sanctuaries dedicated to worship and in homes blessed by family affection to express our gratitude for the glorious gifts of God; and let us earnestly and humbly pray that He will continue to guide and sustain us in the great unfinished tasks of achieving peace, justice, and understanding among all men and nations and of ending misery and suffering wherever they exist.

–Thanksgiving Day, 1963

Article from The Valley Patriot Newspaper: “State Auditor’s Office Protects The Big Swamp From The Law.”

Audit officially started May 7, 2019. Office of State Auditor Suzanne Bump’s Director of Audit Planning and Review Billy Keefe refused to address any of the evidence of fraud prior to the start of the audit. Now that the audit has started he is disregarding it and excluding it from the audit (claiming it would bias results!). He is essentially excluding all evidence of fraud from the Physician Health and Compliance (PHC) Board counsel audit for purposes of determining no fraud exists! Need to terminate this tainted audit ASAP and put a spotlight directly on the documents Keefe is trying to bury.

Disrupted Physician

The article below by Dr. Bharani Padmanabhan was published in The Valley Patriot  in print in April.  Will update when it is available online.

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State Auditor’s Office Protects The Big Swamp From The Law

Bharani Padmanabhan MD PhD

People on food stamps are the lowest rung on the economic ladder, people who need charity just to eat. Going after poor people helps bureaucrats pretend they care about taxpayers. By targetting people on assistance, the state auditor’s office fools everyone by deflecting attention from its refusal to audit high crimes by the ‘elite’ reptiles in control of the Massachusetts swamp.

This week the state auditor’s office preened itself on identifying $10.7 million of Medicaid fraud. In absolute terms this $10.7 million is a hill of beans given that we lose $4 billion annually to healthcare fraud nationally. Given that Massachusetts’ fiscal 2018 healthcare budget is $21.7 billion, this $10.7 million…

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The Need to Put a Spotlight on Physician Health and Compliance Medical Board Attorney Professional Misconduct and Fraud

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The 2006 Duke Lacrosse case put a spotlight on prosecutorial misconduct.  District Attorney Mike Nifong was appropriately disbarred, jailed for a day and disgraced after it was exposed there was no evidentiary basis for the case and that he withheld exculpatory DNA evidence for 9-months.  As the elected D. A.  Nifong had tremendous power over the lives of the accused since no one was going to challenge his discretion.

A spotlight needs to be put on the misconduct of state employed medical board (MLB) attorneys affiliated with state physician health programs (PHPs).   These attorney positions were created for purposes of influencing legal, regulatory and public health policy advancing the interests of the stakeholders and to prevent the corruption and shakedown racket from being exposed by blocking any evidence of misconduct or fraud presented.  They are also tasked with initiating and bringing disciplinary proceedings to a predetermined conclusion if  a physician under monitoring contract is reported  “non-compliant.”  These attorneys  conceal, misrepresent and fabricate evidence.  They essentially function as physician health medical board prosecutors (PHMBS). These attorneys have tremendous power over the lives of the accused and no one challenges their discretion.Screen Shot 2019-02-25 at 10.41.37 PM

The Office of State Auditor Suzanne Bump officially started an investigation of Massachusetts Board of Registration in Medicine  Physician Health and Compliance (PHC) Board Counsel in May.

It is essential that the fraud and egregious misconduct these attorneys are participating in be exposed and that they face disciplinary action.

Screen Shot 2019-02-24 at 3.21.28 PMI am aware of 3 suicides that were the direct result of Physician Health and Compliance Board Counsel managed by attorney Robert Harvey.

Moreover, this misconduct is not isolated to Massachusetts. This systemic abuse of administrative process is ubiquitous.

Through  updated Public Records Law I have obtained previously unobtainable records including all of the evidence submitted to PHC Board Counsel. Much of this evidence was extremely difficult to obtain. These records requests have revealed all documents pertaining to forensic lab fraud were either concealed or omitted by PHC Board Counsel.  The documents have never been before a tribunal.  The “litigation packet” has been fraudulently concealed since December 2011.  The simple fact of the matter is these document show flagrant forensic fraud.  This is not a “chain-of-custody error” and pointing to the words “update” “revise” and “correct” to claim it is means you are either complicit or just plain stupid.  The lab fraud is the exact same type as Dookhan except there was no documentation of her misdeeds as plainly articulated ion these documents and the consequences of these tests extend far beyond the Hinton crime lab and are far more grave.  The fact that V.P. of Laboratory Operations Joseph Jones added an ID number to an already positive test knowing that a person was attached to it by faxed request is sociopathic.  I have seen documents illustrating the same fraud from the same lab signed by this same tub of lard.  The fact that PHC Board counsel concealed documentation of clear criminal fraud involving a state PHP and the drug and alcohol lab used by PHPs nationally is despicable.

I am aware of multiple suicides resulting from this very same test at this same lab.

The second set of documents illustrate how the fraud was covered up.  After an outside investigation the lab was forced to invalidate the test but Joseph Jones added the comment “external chain of custody was not followed per standard protocol” which is technically true but an absurd minimization given he falsely created it at the request of Sanchez. The revised lab was reported to PHP Director Sanchez but instead of disclosing the revised test he reported “non-compliance” with support group meetings (a requirement that resulted from the positive test).    PHC Manager Robert Harvey was provided documentation of full compliance with meetings and no contradictory evidence was ever produced.   

On February 6, 2013 the Board suspended my license and Harvey would not provide the reason so my attorney could file an appeal.  He tolled the time until after the deadline for appeal passed and when my attorney attempted to convince him to extend the appeal deadline Harvey replied “that ship has sailed.”   The statement of reasons for the decision identified 4-documents relied on as evidence.  2-documents contained dates of reported attendance at meetings that were not in dispute.  The other 2-documents claimed to contradict the attendance reports were unknown and unidentifiable.   Under updated Public Records Law effective January 1, 2017 and only through the efforts of lawyers with the Department of Public Records and interventions by the Supervisor of Records all 4-documents were disclosed by the Board’s Records Access Officer Gerard Dolan.  The documents identified amount to 6-pages total.  The documents provide direct documentary proof that none of the contradictory facts exist.  Harvey fraudulently misrepresented an item of evidence submitted on my behalf to corroborate attendance at meetings and a rebuttal argument destroying the entire factual premise of the case.   The attorney misconduct is unprecedented on many levels but the simple fact of the matter the 2-statements presenting the contradictory findings of fact are false and these are 100% material to the decision.

Screen Shot 2019-06-28 at 8.53.34 PM.pngThe Office of the State Auditor does not have the authority to prosecute criminal fraud but they do have the authority to investigate it and report it to the proper agencies.  The documents show criminal fraud and Harvey is the perpetrator and I am a victim of his fraud.  At a minimum this requires investigation by the Board of Bar Overseers as what is seen is egregious.  RAO Dolan has refused to acknowledge the false statements but they are so obvious you would have to close your eyes.  He had a duty to disclose the false statements and take remedial measures when he was made aware of them.  He instead told the attorneys at the Department of Public Records that they had no business reading the documents and their job was just to provide them.  He also told the Supervisor of Records she had no authority to question the Board’s valid Orders.   The Auditor does. Determining the truth or falsity to the statements simply requires reading the asserted facts found in the statements and examining the true facts found in the documents identified as providing them.  This takes about 5-minutes. 

MA BORIM Board counsel Robert Harvey’s Misconduct (part 1)

MA BORIM Board counsel Robert Harvey’s Misconduct (part 2)

“It is as if the Board didn’t see any of the evidence” is a comment I have heard from  scores of doctors, nurses and other healthcare practitioners across the country.   Truth be told they probably didn’t see any of it.

These medical licensing board (MLB) attorney liaisons to physician health programs exist in every state. The infrastructure pertaining to how they operate may differ but what they do in mechanics and mentality remains the same.

Screen Shot 2019-02-26 at 9.20.58 PMThe “PHP-approved” assessment and treatment centers are engaging in fraud through non-existent and exaggerated diagnoses and the contracted  labs are engaging in lab fraud to fabricate positive tests used to coerce the victim into signing a new contract or initiating another.   There is little oversight in the rehab industry and insurance fraud is rampant. Cash only no insurance accepted reduces  accountability to zero.  The drug and alcohol testing laboratory’s utilize non-FDA approved tests with no oversight or Screen Shot 2019-02-26 at 6.22.07 PMregulation–no agency exists that can both investigate and sanction.  PHPs are good organizations that have become corrupted over time by corrupt individuals.  These attorneys monitoring physician health compliance are corrupt individuals who were place within medical boards to add an additional layer of protection.  All evidence supporting the accused is disregarded, deflected or dismissed.  So too is any evidence implicating the PHP or its affiliates in misconduct or fraud.  

Screen Shot 2019-02-25 at 8.06.19 AMWhile the testing and treatment affiliates are engaging in fraud, these attorneys are engaging in “fraud on the court.”   This is an extortion racket where the PHP makes the threat and PHC Board Counsel pulls the trigger.  The monitoring contracts signed with PHPs and letters of Screen Shot 2019-02-25 at 8.05.32 AMagreement signed with medical boards are signed under coercion, undue influence and duress.  If referred to a PHP the  threat of “non-compliance” begins the moment you walk in the door.  If the PHP recommends an evaluation at an out-of-state facility it is done under threat of reporting non-compliance to the medical board with risk of loss of licensure and livelihood.  These are not genuine agreements. There is no mutual assent.

These attorneys have no interest in presenting truth or pursuing justice.  It is also frequently observed that these attorneys do not follow the rules and have no conscience or moral compass–the only external and internal controls that keep any society free and just for everyone.  They have an utter disregard for fact, truth and consequences.

If a PHP reports “non-compliance” they are tasked with initiating the board proceedings and bringing them to a pre-determined conclusion.  They appear to be following a scripted template in which the only stream of evidence that appears before the medical board is the polluted PHP narrative and its affiliated referral sources and assessment, testing and treatment centers.

Screen Shot 2019-02-25 at 9.51.32 AMIt also appears that it is their responsibility to craft and calibrate a statement of reasons for the decision that complies with all legal, regulatory and professional standards.  If the audit of PHC Board Counsel looks at compliance with regulatory,  legal and professional standards they will not detect the fraud.

Paper statements showing compliance are meaningless when taken out of context.  The compliance narrative all too often excludes consideration of how human beings act in organizations.  Corruption by definition is covert and hidden.  The decision making is fragmented.  Accountability firewalls and the diffusion of responsibilities make it difficult to detect individual wrongdoing.

Screen Shot 2019-03-24 at 1.45.57 AMThese attorneys  are engaging in factual misconduct.  They hide and conceal and misrepresent and fabricate evidence to support the decision.  Almost everyone who is unjustly coerced into a PHP obtains 2nd. 3rd and even 4th opinions from bona fide experts and here that includes world class facilities and some of the top experts in the field.  The auditors need to look at the statement of reasons for the decision, verify the facts asserted and examine the records for what is missing.  If my records are any indication they scan the records into the Board’s Digital Imaging Unit after the Board meetings for which they were submitted.

Screen Shot 2019-02-24 at 4.35.41 PMThey are able to freely engage in false misrepresentation and fraud because of the flawed policy and procedure intentionally put in place for exactly this reason.  This policy and procedure benefits the  stakeholders in the drug and alcohol testing, assessment and treatment industry and remove all due process rights of the accused. PHC Board Counsel have removed the right to a full and fair hearing.  They have removed the right to present evidence and argument supporting one’s case.

Board Policy 94-002  created the position of PHC Board Counsel outside the Enforcement Division of the Massachusetts Board of Registration in Medicine (Board). Policy 94-002 includes the provision that PHC Board Counsel be able to act as their own hearing officers in cases involving physician health and compliance issues.   The Board appoints a “hearing officer” to conduct an adjudicatory proceeding according to the procedures set forth in the Massachusetts Administrative Procedures Act. Mass. Gen. L. ch. 30A. 

It is the hearing officers responsibility to make all decisions regarding the admission or exclusion of evidence.  They not only prepare and present cases to the Board but have carte blanche power to pick and choose what evidence is presented to the Board.  They have also blocked the ability of the accused to ever get evidence before the full boardand it is foolproof.  The only opportunity for a hearing is before a single Board member.

The procedures for violation of probation agreement. (adopted June 9, 1993) dictate what occurs in the event of a report of “non-compliance.”  They allow the unilateral presentation of evidence to the full board at a “meeting.”  If the Board votes to suspend Screen Shot 2019-02-25 at 9.53.43 PMthen a hearing can be requested before a single board member within a limited time-frame but the hearing officer has full discretion of what evidence is accepted.  These mechanisms completely blocking the ability to get evidence before the full Board were Screen Shot 2019-02-26 at 1.30.17 PMput in place because Board members come and go.  For risk management in preventing an honest  Board member with integrity from possibly seeing something and asking too many questions they simple introduced procedures that remove the risk and use the 1 or 2 unethical Board members they can trust to rubber-stamp the determination and decision. The wrongdoing seen here cannot be minimized.


Please contribute to my Gofundme.  Attorney Harvey’s misconduct and fraud has caused a great deal of harm to my 3-daughters especially my youngest daughter Josephine who had to leave her school because of these crimes. We are about to suffer another major loss and would greatly appreciate any help to avoid it.  Also please help me hold this guy accountable!


February 6, 2013 Board Order(annotated)

EXHIBIT 2 (Documents identified as providing evidentiary facts presented in 2013 Order Statement of Reasons 9-12) (1)

Statements (9) and (11) present true findings of fact but misrepresent the same attendance records as distinctly different


Statement (10) and (12) are false statements and intentional fraudulent misrepresentations.






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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!


Disrupted Physician

photo “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…

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The Lemonheads—Beautiful

Disrupted Physician

Video post by @mllangan1.

Every day is so wonderful
Then suddenly it’s hard to breathe.
Now and then I get insecure
From all the pain, I’m so ashamed.

I am beautiful no matter what they say.
Words can’t bring me down.
I am beautiful in every single way.
Yes, words can’t bring me down… Oh no.
So don’t you bring me down today.

To all your friends you’re delirious,
So consumed in all your doom.
Trying hard to fill the emptiness.
The pieces gone, left the puzzle undone.
is that the way it is?

Source: The Lemonheads – Beautiful

Written by Linda Perry.

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:


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.