Backfire Step 3: REFRAME –Fraudulent Concealment of Fabricated Forensic test correction, False Statements Under Color of Law : Need to hold accountable

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Laboratory developed tests (LDTs) have no FDA or CLIA oversight.  Avoiding regulatory oversight is just one of the ways those involved in the use of these tests avoid accountability.  Without answerability to third parties they have essentially removed themselves from consequences.

College of American Pathologists (CAP) accreditation is the sole avenue for complaint.  CAP does not sanction.  They only have the ability to educate lab to come under compliance with CAP standards under threat of loss of accreditation and it is under this threat that they can force a laboratory to correct both unintentional and intentional errors.  This is what was done in my case.

I filed a complaint with CAP in January of 2012.  The “Litigation packet ” showing forensic fraud was sent to CAP and I was informed that the investigation could take many months.    In October of 2012 I was suddenly reported to the Board of Registration in Medicine for  “noncompliance” with AA meetings (that were the sole and direct result of this test) and action was taken against my medical license which resulted in my suspension.

In December of 2012,  the Chief Investigator for CAP, Amy Daniels  called me to see how I was doing in light of the “amended” test.  She told me that the test had been invalidated on October 4, 2012.   I told her this was news to me as I was in the process of being suspended for “noncompliance” and called the Director of Operations at Physician Health Services (PHS) Linda Bresnahan who predictably told me she was unaware of any revision to the test.

But the very next day a letter was  sent out  signed by PHS Medical Director Dr. Luis Sanchez, M.D. stating that they had just  found out about the amended test on December 10. 2012, the day before when I called them.  Interestingly the letter acknowledged the invalidity of the test but  stated PHS and the BORM would  “continue to disregard” it.  Sanchez also made it a point in the letter to state they were  were not aware of any consequences resulting from it.  They denied any knowledge of an October 4, 2012 revision which would have been 67-days earlier than this acknowledgment and dismissal of the test.

In response to 93-A demand letters from my attorney for fraud, PHS, Quest and USDTL all refused to consider any damages by blaming my suspension on me.   They claimed my suspension was due to my “noncompliance” with attending AA meetings that was officially reported to the Board October 18, 2012.     The claimed the test that was used as a stepping-stone for all subsequent adverse events was completely irrelevant and had nothing to do with anything.    This is what is known as “moving the goalpost.”   What they did not know was that I would eventually be able to get the document proving they knew what they knew and when they knew it.

The response letters revealed important information that was previously only speculative with no way to prove.  Both labs, in defense, claimed that  the test was sent as “clinical” specimen at the request of PHS (an ultra vires out of scope act as they are a 503(B) charity. PHS is not a healthcare provider and is not authorized to practice medicine.

PHS and the labs were apparently unaware of the new HIPAA Privacy rule that requires labs to provide patients with their lab tests without approval from the agency ordering the test.  PHS had previously refused to provide labs by hiding under confidentiality and medical records regulations.

At first they refused but CAP and the DOJ -civil rights division forced USDTL to provide the document below dated October 4, 2012 informing Dr. Luis Sanchez of the amended test he reported in a signed letter to a state agency that he had just found out about December 10, 2012.  The letter undeniably shows Sanchez lied to a state agency in a written letter.  This is also a prima facie crime.  It is just one of many crimes that Board Attorney Deb Stoller has facilitated for PHS as her job is to ignore, suppress, minimize and deflect any criminal acts committed by PHS and protect them.  And this needs to be made public.  PHS needs to be held accountable.  So too do the actions of Ms. Stoller whose job as an agent of the state makes her involvement even more egregious than the perpetrators.

The documents below show a clear violation of M.G.L. 256 (B) Section 69 done under Color of Law.

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Title 18, U.S.C., Section 242
Deprivation of Rights Under Color of Law

This statute makes it a crime for any person acting under color of law, statute, ordinance, regulation, or custom to willfully deprive or cause to be deprived from any person those rights, privileges, or immunities secured or protected by the Constitution and laws of the U.S.

This law further prohibits a person acting under color of law, statute, ordinance, regulation or custom to willfully subject or cause to be subjected any person to different punishments, pains, or penalties, than those prescribed for punishment of citizens on account of such person being an alien or by reason of his/her color or race.

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False Statements Relating to Health Care Matters (18 U.S.C. § 1035) It is a crime to knowingly and willfully falsify or conceal a material fact, make any materially false statement, or use any materially false, fictitious, or fraudulent writing or document in connection with the delivery of or payment for health care benefits, items, or services. 11 Chapter 2 ~ Summary of Fraud and Abuse Laws


Mail and Wire Fraud (18 U.S.C. §§1341 and 1343)  Statutes, which prohibit the use of the mails or the wires to further “schemes” to defraud


Perjury and False Statements

PERJURY BY WRITTEN INSTRUMENT. 

FALSE STATEMENTS (18 U.S.C. § 1001)

This statute prohibits the making of any false, fictitious, or fraudulent statement to the United States or a government agency. This statute is exceedingly broad: It covers any statement or representation made to the government or any of its agents. A statement can be made either orally or in writing, and it can be sworn or unsworn.


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Supression of Dissent: Basic Information

2. The keys to backfire

• “Reveal: expose the injustice, challenge cover-up

• Redeem: validate the target, challenge devaluation

• Reframe: emphasize the injustice, counter reinterpretation

• Redirect: mobilize support, be wary of official channels• Resist: stand up to intimidation and bribery”

via Helpful resources for those abused and afraid — via http://www.bmartin.cc .

ASAM/FSPHP/LMDs

ASAM/FSPHP/LMD   Blueprint  

Front-Groups representing corporate (drug testing labs, EAPs, inpatient treatment industry) and political (prohibitionist, war on drugs, AA 12-step paradigm of addiction)  interests.

American Society of Addiction Medicine ( http://www.asam.org )  –ASAM primarily a lobbying group/special interest group.  Origins can be directly traced to Alcoholics Anonymous (A.A.) and started by Dr. Ruth Fox.  Goal originally to get the medical establishment to accept the chronic brain disease model and 12-step spirituality as the only treatment for alcoholism.

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Federation of State Physician Health Programs   (http://www.fsphp.org )–ASAM  took over state Physician Health Programs (PHPs) by joining state PHPs and outnumbering non-ASAM physicians were eventually weeded out (removed, contracts not renewed, retired)

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Like Minded Docs (http://www.likemindeddocs.com/about-us.html )–a right wing conservative subset of ASAM.  12-step ideology and facilitation primary goals.  

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Physician Health Programs and Professional Health Programs (PHPs)–started in the 1970s as “impaired physician” programs and existed in every state by 1980.  Changed to Physician Health Programs (PHPs) to focus on wellness rather than impairment.  Organizational goal to help sick doctors and protect the public and originally funded by medical societies and staffed by volunteer physicians.  Now taken over by ASAM doctors.

Map below shows number of ASAM certified physicians by State in 1988 (ASAM then known as AMSAODD).

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ASAM/ABAM  “Board Certification” not recognized by American Board of Medical Specialties.

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Group of physicians “in recovery” In 1986 started calling themselves “experts” in addiction medicine. Addiction Psychiatry only recognized subspecialty in addiction medicine and requires 4 year psychiatry residency and 1 year of fellowship at an accredited training program and stringent testing and oversight.

ABAM certification requires only an MD and board certification in ANY specialty.

Aced it!

Aced it!

ABAM certification = Diploma Mill.  Started in 1986.

I took exam in 2010 to make this point and passed by 65 points with a score of 459 (Passing = 394).

Purpose of Diploma Mill = Profiteering from multi-billion dollar treatment industry now dominated by the “Minnesota Model” (i.e. addiction is a chronic “brain-disease,” complete abstinence, life-long spiritual recovery (AA, 12-step).

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 “PHP-approved” assessment and treatment centers.  State PHPs and the FSPHP mandate that any assessment  and treatment be done at a “PHP-approved” assessment and treatment center and exclude non-PHP approved assessment and treatment centers.

No criteria or list of “PHP-approved” assessment and treatment centers. None exist.  All of the “PHP-approved” facilities can be correlated with list of Like-Minded Docs.  LMDs are medical directors of all “PHP-approved” assessment and treatment centers.

Major Issues:

1.  state Medical Boards are mandating doctors for evaluations at facilities for which no criteria exists for PHP”approval.”  ? Anti-trust

2.  Establishment Clause violations –doctors being mandated to 12-step facilities only.

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Number of physicians in US board certified in Addiction Psychiatry = around 1000

Number of physicians in US “board certified” by ASAM = over 4000

Who are they? The majority of these physicians are “recovered” addicts and alcoholics who had licenses revoked. They were able to regain their licenses by convincing State Medical Boards that they were 1) Recovered, reformed, redeemed. 2) Societal need for addiction medicine doctors.   Convinced boards that if their licenses were restored they would altruistically dedicate their lives to helping other addicts and alcoholics. Win-win situation.

Licenses restored they then became “certified” in addiction medicine.

Where did they go?     1) Joined PHP programs funded by State Medical Societies and staffed by volunteer physicians. 2). Staffed 12-step inpatient drug rehabilitation programs as Medical Directors.

The State PHPs were “sitting ducks.” The equivalent of other employee EAPs but without protection (i.e. no union or worker organization set up to protect a doctors interests) No oversight, regulation, inspection, or transparency but layers of procedural protection).

They systematically and slowly took over the PHPs in each State and now monopolize the system.     Physicians who did not go along with the “groupthink” were removed over time.

In Massachusetts the coup was accomplished when Dr. John Knight, M.D. was removed in 2009 and Dr. J. Wesley Boyd, M.D, PhD   was removed in 2010.

http://connects.catalyst.harvard.edu/Profiles/display/Person/85877 http://connects.catalyst.harvard.edu/Profiles/display/Person/85647

http://www.jwesleyboyd.com/?p=280

Physicians removed from PHPs were threatened with swift and certain consequences if they violated confidentiality agreements or “peer review” protection.   “Win or lose, you’ll lose everything. Most effective, however, was the implied and unspoken threat that if they did not do as they asked they could end up being monitored by them. (having been witness to ethical violations and criminal activity committed with impunity the message was heard loud and clear.

The State PHPs taken over by the ASAM physicians are under the umbrella organization FSPHP.

http://www.fsphp.org

PHS formally entered into this partnership in 2013.

http://www.massmed.org/News-and-Publications/Vital-Signs/PHS-Partners-with-the-Federation-of-State-Physician-Health-Programs/#.U2ElTl5oOCg

The ASAM staffed treatment centers are also under an umbrella organization.

https://www.naatp.org

Conservative subset of the ASAM “Like-Minded Docs”

http://www.likemindeddocs.com/about-us.html

In reviewing my records please note that every person involved in my “assessment” and “treatment.” Has been a Like-Minded Doc including the Medical Review Officer at PHS, Wayne Gavryck, a former alcoholic and graduate of the program with a history of malpractice and no qualifications. (in contrast to Knight and Boyd he has no publications, teaching, or academic affiliations. He is also the person at PHS who should have thrown out the PEth test.

Primary purpose = Profit and monopoly. Who profits?

http://www.alternet.org/civil-liberties/random-drug-testing-all-chilling-proposal-key-addiction-journal-major-invasion

http://en.wikipedia.org/wiki/Robert_DuPont

http://www.thenation.com/article/173654/gops-drug-testing-dragnet#

2). The drug testing companies.

How does it work?    Like-Minded Docs is to the ASAM what the Tea-Party is to the GOP and the FSPHP are the brown-shirts of the group.

How it Works

Step 1) Positive Urine -(below cutoff metabolite of prescribed med, fabricated) Disregard for MRO standards and protocol.   Ignore guidelines and standards of care. Report any and all positives to Boards of Medicine (Boyd and Knight discuss). http://bit.ly/19iXBq3

Step 2) Refer for an evaluation at a facility experienced in the diagnosis and treatment of health care professionals (Hazelden, Bradford, Talbott,). Hearing same pattern across the country. Neuropsychological assessment fraud with diagnosis of “denial” based on elevated L-score on MMPI and “cognitive impairment” based on shaving off executive function points on the Wechsler IQ scale.   Deem unable to practice medicine and recommend 1-4 month inpatient rehabilitation. 

Step 3) “noncompliance” default.   With PHS programs the “trump card” is to call the monitored physician “noncompliant” and report it to the board.

In my case

  1. Wayne Gavryck, MD. Medical Review Officer for PHS, Inc. Reported PEth test as positive July 19th, 2011.  

Have documentation confirming collusion PHS with USDTL to commit fraud (2011)

  1. Based on the positive PEth recommended an evaluation at a facility experienced in the “evaluation and treatment of health care professionals.” Given 3 choices. 

Talbott –Medical Director Paul Earley

Hazelden—Medical Director Omar Manajwela in 2011, and now Marv Seppala.

Bradford—Medical Director Mike Wilkerson

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Have documentation confirming collusion with Talbott Rehabilitation Center to commit fraud (2008) .   Had evaluation in 2008 under Paul Earley.-Fabricated MMPI. Documented by oversight Board.

I chose Hazelden.. Dr. Omar Manajwela did not find any history of alcohol abuse (past or present) and I was not admitted for treatment.      He could not explain the positive PEth test, however, so recommended AA meetings. I informed Hazelden I had requested the “litigation packet” as I suspected fraud and was told they could revise my discharge summary if I was able to prove this.

Linda Bresnahan then requested I verify attendance at AA meetings by giving them phone numbers of anonymous attendees and said that it was the recommendation of Hazelden. Made multiple requests to Dr. Omar Manajwela to verify that 1) he did not recommend this , and 2) that it was inappropriate. He refused.

 

I obtained the “litigation pack” that showed forensic fraud. Documents show collusion with labs to both produce the positive test (USDTL, Fax from PHS, inc. to USDTL requesting a chain of custody be added to an already positive test) and cover-up (Quest diagnostics). Confirmed fraud after investigation by The College of American Pathologists). CAP forced USDTL to change PEth from “positive” to “invalid.” This was done 10/4/2012.

I contacted Hazelden multiple times and sent them the litigation packet showing misconduct and asked that they revise my record and recommendations.

 

Dr. Marv Seppala,Medical, Director of Hazelden, acknowledged the test was invalid but refused to make any changes in my records or help me convey this to the BORM.


PHS called me “noncompliant” 10/8/2012.

PHS barred me from using my asthma medication. With a history of severe asthma since childhood, it had been under control for 10 years.   Had multiple cold induced asthma attacks documented by Dr. Bierer. Had to stop exercising at gym I had been going to almost every day for years.

After suffering a cracked molar I was told it would require partial sedation by orthodontist. Told Dr. Chinman who told me they would test my hair and if they found anything “that would be it”. Left untreated 9 months. I chewed on one side of my mouth and tolerated the pain.

They also tried to financially torture me. Multiple excessive charges billed by PHS with demand that I pay or they would report me to the BORM for noncompliance. These are tests that were not even done and an audit of PHS would reveal them to be false. I told Dr. Chinman I was having financial difficulties because of what was occurring but that I had put . $2000.00 away for Christmas presents. The next day Linda Bresnahan demanded $2000.0 under threat of reporting me to the Board.  

 I requested a day off from testing because my daughters were dancing in Providence in the Irish Step dancing finals (Oireachtas) and would not be available that day. The day before the Oireachtas he called me and told me he had to change our monthly appointment and the only time he could see me was the next day, it was mandatory, and if I did not he would report me to the BORM.   The appointment was the exact same time my daughters were dancing. He looked it up.

Robert Dupont – Former White House Drug Czar (1973 to 1977) and the Director of the National   Institute on Drug Abuse(NIDA) (1973-1978). Fellow of the American Society of Addiction Medicine. Founding President of the Institute for Behavior and Health, Inc. He and Peter B. Bensinger (former DEA administrator) founded Bensinger, Dupont, & Associates, a national consulting firm that specializes in workplace drug testing(EAP). ( http://bit.ly/1nNjWzi ).

Former architect and champion of Straight Inc. There have been multiple suicides of kids abused by these programs. Memorial FB page of those who died from these programs. http://on.fb.me/1mtmQOf   http://bit.ly/1c2Mv6

PHP model based on this model “New paradigm” PHP model of substance abuse treatment based on single methodologically flawed study of 902 physicians (retrospective non-blinded cohort) with false endpoints to hide the number of suicides. Claiming 80% success rate . No Cochrane or other critical review. Biased opinion piece. Sole basis for “gold standard.”   http://bit.ly/N0fMbN

http://bit.ly/N0fMbN.

Greg Skipper—Introduced EtG as biomarker for alcohol testing based on little science. Partnered with F. Wurst (who holds the patent). Came up with arbitrary cutoff of 100, tested it on doctors in the Alabama PHP program, and marketed it to a drug testing company as proof positive of alcohol ingestion. Ruined countless (hand sanitizer alone can cause levels > 2000). SAMHSA advisory put out stating little science and advising against its use. Very poor sensitivity hand sanitizer alone can cause levels of 2000) Most EAP’s abandoned it but PHPs (and a handful of other programs where the tester has absolute control and the person being tested has none) continued to use it. Now introduced PEth as confirmation of drinking in combination with the EtG. Like the EtG there is no evidence base and specificity unknown. Also proselytizing Soberlink alcohol testing device

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Without Dr. William Morgan the 2004 Red Sox World Series win would not exist–a true Boston Hero

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The essay below found on 123HelpMe.com called The “Doctor Who Saved Boston.” is about Dr. William J. Morgan, the brilliant hand surgeon who helped the Red Sox win the World Series for the first time in 86 years.  Morgan performed  surgery on Curt Schilling’s severely damaged ankle that allowed him to pitch in game 6 of the ALCS against the Yankees when we were down three games to two.
No known medical or surgical options existed to allow Schilling the functionality to pitch.  But just as things were looking bleak Dr. Morgan miraculously performed an unprecedented procedure he invented that allowed Schilling to pitch seven innings winning the game 4-2.   He created a wall of stitches to hold Schillling’s torn tendon sheath in place before game 6’s win and again before game 2 of the World Series that we also won.
And October 27. 2004 is a magical date for red sox fan.  Watching it unfold with my wife and daughters and the joy and excitement that followed is a vivid memory for me that I will never forget and it should be noted that without Dr. Morgan that night would never have happened.  Without Dr. Morgan the curse would not have been reversed.  He is a true Boston hero.   But, as with all of us, he is not perfect.  In November of 2003 he was arrested for driving under the influence and, as a Massachusetts doctor, he was mandated to Physician Health services (PHS) under a monitoring contract.  According to news sources from February of 2010 Dr. Morgan was forced to give up his right to practice medicine in Massachusetts as a result of “unspecified allegations” and reading these reports the assumption that he must have done something very wrong is assumed–a logical and rational conclusion based on how we assume the world works.
I was reminded of doctor Morgan because today is opening day for the Red Sox.  Over the past couple weeks I have been contacted on average four time a day by doctors who are currently suffering under their state physician health programs or by those who wanted to tell me of the circumstances surrounding the suicides of doctors they loved.  The stories  I have been hearing are heartbreaking and unreal but the patterns are the same. One of the most bothersome facts is that I have yet to hear from anyone who was truly an addict or alcoholic.  Like Dr. Morgan, some life event bought them a one-way ticket into a PHP and from that point on their lives and locus of control was placed in the hands of others.  Most of the doctors I have spoken to are good and kind doctors who were referred for situational factors and one-offs–mistakes or circumstances that were transient.  Many were given positive tests using the non-FDA approved laboratory developed tests (LDTs) and pulled out of practice resulting in suicide.
The “unspecified allegation” leading to Dr. Morgans 2010 loss of license was that he had a positive Phosphatidyl-ethanol (Peth) test ordered by Dr. Luis Sanchez and reported as positive by USDTL. And as seen here, these two cannot be trusted.   Intentional fraud perpetrated in this manner requires zero tolerance. It also brings into question the validity of all testing done by PHS and performed by USDTL.   It is extremely concerning that criminal acts done under color of law is not being addressed by the state medical society and the Department of Health (DPH).

The sociologist Stanley Cohen’s States of Denial: Knowing about Atrocities and Suffering (Polity Press, 2001) systematically analyzes processes of denial by both individuals and governments and describes five methods of denial:

1. Deny responsibility: “I don’t know a thing about it.”

2. Deny injury: “It didn’t really cause any harm.”

3. Deny the victim: “They had it coming to them.”

4. Condemn the condemner: “They’re corrupt hypocrites.”

5. Appeal to higher loyalties: “I owe it to my mates.”… 

None of these apply here.   I happen to know that the positive test  given to Dr. Morgan was not the result of anything he did.   Sanchez and Jones claim professionalism and high ethical standards but the undeniable evidence shows they are unethical individuals engaging in criminal acts.    These need to be exposed and those involved need to be held accountable.
Schadenfreude is a word taken from German and literally means “harm-joy.”   Along with psychopathy and narcissism. schadenfreude seems to be a common characteristic of those involved in PHPs.   Deriving pleasure in the misfortunes of others and particularly if that person is someone who represents what they could never be.   I understand they took particular pleasure in bringing down Dr. Morgan and he deserves to be restored to his status as a true Boston hero. The city of Boston and Red Sox fans everywhere have the responsibility to make sure they be charged criminally by law enforcement.   We owe it to Dr. Morgan and any others who have been victimized by the Massachusetts PHP.
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The Doctor Who Saved Boston

The memories of the Red Sox run to the 2004 World Series championship this year will remain in the minds of Sox fans forever.   It is about Dr. William J. Morgan, a brilliant hand surgeon who performed a risky

Whether it is David Ortiz’s walk off performances against the Angels and Yankees, Manny Ramirez’s tape measure home runs, or Derek Lowe winning the clinching games of all three playoff series, Red Sox nation will not soon forget the memories that the “bunch of idiots,” as centerfielder Johnny Damon dubbed this year’s Sox club,provided them, nor will they forget the Sox all out assault on baseball and Boston sports history.

But of all the images the fans retain, of all the feelings they experienced, of all the heroes Sox nation put on an altar and worshipped – the most memorable has to be Curt Schilling pitching three games on an inured ankle, blood from broken sutures seeping through his sock and a look of obvious discomfort on his face, winning two, and capturing the heart’s of every member of Red Sox nation. images-37

But to understand the elation of the Nation and the reason that it has turned Curt Schilling into a God in the church that Cy Young, Ted Williams, and Carl Yaztremski built, we have to take a step back and remember the predicament that the Red Sox were in just over two months ago.

It was October 12, and the Yankees had beaten the Red Sox in Game one of the ALCS. It was only one game, but that familiar feeling was back. That familiar feeling that Red sox fans have of doom and gloom lingering just over the horizon returned.

Curt Schilling, the hired gun, the man who Sox management had brought in to beat the Yankees in just this situation, had not only lost the game, but looked utterly ineffective in doing so, allowing six runs in just three innings of work and the media was reporting that Schilling may not pitch again.

On June 10, reports came out on ESPN and in the Boston papers that Schilling had a minor injury to his ankle but that he would pitch through it and make his start that night and would not have to go on the disabled list.What came out later on in the papers was that Schilling had made the majority of his starts in the 2004 season only after undergoing shots of marcaine, which sportsinjuries.com describes as a long lasting local anesthesia that is used for pain management and works by blocking nerve sensations.The attitude that the Red Sox seemed to take toward Schilling’s injury was no harm, no foul, and after June little was heard about Schilling’s ankle, that is until October 5.October 5 was the beginning, and almost the end, of the Red Sox 2004 playoff run. It was a glorious, and infamous, day in Red Sox history. Curt Schilling pitched 6 and 2/3 strong innings at Anaheim, allowing just two runs and scattering nine hits as the Red Sox cruised to a 9-3 victory.

But late in the sixth inning, Schilling pulled up lame after fielding a slow roller down the first base line and throwing the ball over first baseman Kevin Millar’s head. He was favoring that same right ankle that had been hurting him all year.

Back to October 12, and the feelings of anxiety that every Sox fan from Maine to Rhode Island no doubt had in the pit of their stomachs. Questions were swirling around Boston. Just how serious was Schillings injury? Could he pitch again? Would he pitch again? Is there a God?

Jamie Musler, an assistant clinical specialist at Northeastern, put the injury into perspective.

Musler said that Schilling tore the tissue that covers his peroneal tendon, which sits in a small groove in the fibula and is partly responsible for moving and planting the foot. Musler said that this type of injury is caused by a traumatic event to the foot or ankle, like a significant ankle sprain, and when Schilling was moving his foot, the tendon was slipping out and causing an uncomfortable, but not necessarily painful, snapping sensation because the tendon was snapping across the fibula. This, Musler said, would directly affect foot mechanics and cause a huge problem in Schilling’s delivery.

And it would present a huge road block in Boston’s attempt to win a World Series title.

Schilling meant more to the 2004 Red Sox club than any other player. He was the tone setter and the ace, and without him the Sox would have no chance against the hated Yankees.

The Red Sox needed Schilling, because number two starter Pedro Martinez is not the fire balling Dominican dandy he used to be. And the Yankees, it seemed, had his number of late after he lost two late season starts to them, prompting Pedro to say in a press conference after one of those losses that he could “just tip my hat and call the Yankees my daddy.”

After Pedro, things got even bleaker, with inconsistent and fragile Derek Lowe, aging and unpredictable knuckleballer Tim Wakefield, and young, playoff inexperienced Bronson Arroyo filling out the rotation. These four hurlers are serviceable and talented major league pitchers, but they were not the automatic win that Schilling had proved himself to be in postseason’s past, especially in 2001, when he garnered co-MVP honors after defeating the Yankees in the World Series.

So in comes the man from behind the scenes. The man who would help the Red Sox end 86 years of playoff futility, Red Sox team doctor Bill Morgan, who talked about the injury and treatment in “Faith Rewarded,” the DVD that the New England Sports Network (NESN) recently released.

“It was a very unique situation. Either we did this or (Schilling) didn’t pitch,” Morgan said. “And he was determined that he was going to pitch, no matter what it took.” But what could Morgan do?

What followed was possibly the most publicized treatment of a sports injury in history. One could not turn on a New England news program or open up a New England paper without the top story being about Curt Schilling’s right ankle.

First, according to boston.com, the Red Sox front office brought in Dr. George H. Theodore, chief of foot and ankle service at Massachusetts General Hospital, to help Dr. Morgan try to create a brace to immobilize Schilling’s ankle while he pitched. The idea was that by eliminating movement of the ankle he would eliminate movement of the tendon and eliminate the sensation. But the problem, Schilling insisted, was that the sensation was altering his delivery, and that became apparent after his struggles in Game one of the ALCS. File that idea in the circular cabinet.

Next on the block, according to boston.com, was pair of customized cleats. Morgan had Reebok play around with different styles of cleats, from high tops to low tops, raised bottoms to lowered bottoms, in an attempt to find Schilling a comfortable medium. No dice. Schilling still could not get comfortable.

According to the Massachusetts Medical Board’s website, Dr. William Morgan is an orthopedic surgeon who specializes in hand surgery. He has his own private practice in Brighton, but his primary work setting is in hospitals. Morgan works out of several area hospitals and rehabilitation centers, including St. Elizabeth’s Medical Center of Boston and New England Baptist Hospital, New England Rehabilitation Services of Central Massachusetts, Worcester Medical Center, and University of Massachusetts Memorial Medical Center. Morgan also works out of the Massachusetts Hospital School.

Morgan got his degree from the Texas Medical College and Hospital in Galveston, Texas. He received post graduate training at the University of Massachusetts Medical Center. He continued his post grad training in hand and upper extremity surgery at the Roosevelt Hospital in New York, Brigham and Women’s Hospital, New England Baptist Hospital, and the Kantonspittal in Basle, Switzerland.

Morgan performed successful wrist surgery on one former Boston Red Sox superstar shortstop Nomar Garciaparra, allowing him to come back from what could have been a career altering injury as the All Star he was before he was injured.

The point is that Morgan is not some shaky med student on his first hospital residency. He has been around the block a few times and he knows his orthopedic surgery.

Musler said that with any injury, a doctor has to analyze it by thinking “what is the injury? What can we do to keep the tendon in place? If the feeling is throwing (Schilling) off, how do we help that?”

Morgan, it would seem, did just that, and came up with a new treatment, which he based off of the usual treatment for Schilling’s injury. Musler said that the usual treatment for the injury is to go in and deepen the groove that the peroneal tendon sits in. Musler showed me a video of the procedure in which surgeons cut away the tissue surrounding the tendon and the tendon sheath and then used a surgical drill and chisel to physically deepen the groove in the fibula that the tendon sits in. The surgeons then sutured the sheath back in place and closed the opening.
But Morgan and the Sox didn’t have that much time. They had four days. They went in, did the procedure, gave Schilling another marcaine shot, and, as they say, the rest is history.

Schilling came back and won game six against the Yankees. After the game, Morgan took out the sutures, Musler said, to avoid infection.

Morgan did the procedure again before Game two of the World Series, and Schilling would later say that had the series gone past four games he and Morgan had decided not to do the procedure again and that Schilling would shut it down for the rest of the series.

This time, Schilling was pitching on what is the biggest stage in sports, the World Series, against the best hitting team in baseball, the St. Louis Cardinals, whose line up featured Albert Pujols, the best young hitter in baseball and an MVP candidate, Scott Rolen, the RBI leader in the NL during the regular season, hard hitting and speedy shortstop Edgar Renteria, and two probable Hall of Famers in outfielders Larry Walker and Jim Edmonds.

Schilling was dominant. He made the heralded and hyped Cardinal offense look like a team of Little Leaguers as he pitched six strong innings allowing no earned runs and only four hits.
The rest, as they say, is history. The Sox would go on to sweep the Cardinals in four games, ending their 86 year dry spell of World Series titles and sending New England into a euphoria that it has still not recovered from.

But one has to wonder if there will be any lingering effects from the injury. Will Schilling be alright to pitch next year as the Sox try to repeat as champs?

Mary J. Hickey, an Assistant Clinical Specialist in the Northeastern department of Physical therapy, thinks so.

“Curt made an informed choice about his ankle. I don’t think there will be any long lasting damage,” Hickey said.

But Schilling is not out of the woods yet. Hickey said that Schilling faces at least four to six weeks in a cast, during which he will be seen often by Morgan and the Red Sox medical staff, and Musler said that Schilling faces five to six months of rehab to get back his range of motion, endurance, strength, and sports’ skill. Musler said that this could risk further injury if Schilling is not properly prepared for next season and presses when he is not ready.

Regardless of rehab and healing time, Curt Schilling and Red Sox fans are on cloud nine. The Red Sox are World Series champions for the first time in 86 years, and Sox fans have a new hero and new memories.

The memory of Curt Schilling, of him pitching hurt, grimacing in the dugout, bloody sock and all, will remain with everyone who saw it, even Yankees fans, forever. Schilling billed himself as the hired gun, a man who said in an interview with the Boston Herald before the ALCS that “he was not sure of any scenario more enjoyable than making 55,000 people from New York shut up.” But in the end he was so much more than just a hired gun, he was a hero in real red socks. And he made more than 55,000 people from Boston stand up and applaud as he became the newest Red Sox player to be canonized in the church of Red Sox nation, alongside Yaz, the Kid, Pudge and Cy.

And not to be forgotten is the man behind the scenes, the quiet and unassuming surgeon who made it all possible, Dr. William Morgan, whose name will be forever linked to Curt Schilling, the Red Sox and the 2004 World Series. He may not have thrown a pitch or swung a bat, but William Morgan saved the 2004 Boston Red Sox from being another team that just missed. And he saved Red Sox fans from finally having to utter those awful words – “wait ‘til next year.” But because of Bill Morgan and the entire Red Sox medical staff, next year is this year.

TT Wilsons PHP Playbook–Feel Good Fallacies, False Dichotomies and Frontal Lobotomies

images-34Although 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.

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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.

Featured Image -- 31210Complaints 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!

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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.

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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!!


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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.

Under the nom de plume of “TT Wilson” the author presents non-sequitur and fallacious logic to promote drug courts, PHPs and the sanctification of an illegitimate  and irrational medical specialty.

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.

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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.

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Thank you for your response. ✨

johnnyLawrence

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Disrupted Physician 101.2: “Addiction Medicine” is a Self-Designated Practice Specialty Unrecognized by the American Board of Medical Specialties–(An AMA Census Term Indicating Neither Training nor Competence)

mllangan1's avatarDisrupted Physician

V0011377 A quack doctor selling remedies from his caravan; satirizingEducational and Professional Standards in Medical Specialties and Subspecialties

The increasingly rapid growth and complexity of medical knowledge in twentieth century American medicine resulted in the creation of specialties and subspecialties.

A related development was the creation of “boards”  to “certify” physicians as  knowledgeable and competent in the specialties and subspecialties in which they claimed to have expertise.   The American Board of Ophthalmology, organized in 1917, was the first of these.

As the number of medical specialties proliferated an umbrella organization was formed to accomplish this task. The Advisory Board for Medical Specialties was created  in 1933 and reorganized as the American Board of Medical Specialties (ABMS) in 1970.  This non-profit organization oversees board certification of all physician specialists and sub-specialists in the United States.

The ABMS recognizes 24 medical specialties in which physicians can pursue additional training and education to pursue Board Certification.Screen Shot 2014-11-07 at 7.44.56 PM

In 1991 the American Board of Medical Genetics was…

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EtG–The Rosie Ruiz of Bent Science and Bad Medicine

mllangan1's avatarDisrupted Physician

The Displacement of the idea that facts and evidence matter, by the idea that everything boils down to subjective interests and perspectives is — second only to American political campaigns — the most prominent and pernicious manifestation of anti-intellectualism in our time. — Larry Laudan, Science and Relativism (1990)Screen Shot 2015-03-19 at 11.55.08 PMOn April 21, 1980 Rosie Ruiz appeared to win the 84th Boston Marathon’s female category with a time of 2:31:56.  Her time would have been the fastest female time in Boston Marathon history and and the third-fastest female time ever recorded in any marathon.

“Miss Ruiz, an administrative assistant for Metal Trading Inc. in Manhattan, received the traditional laurel wreath, a medal and a silver bowl for her victory,” According to the New York Times

Ruiz was unknown in the running world and her victory raised suspicions.  After studying marathon photographs she didn’t appear in any of them until the very end and conducting…

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Quacks Pretend To Cure Other Men’s Disorders But Rarely Find A Cure For Their Own – Part Eighteen

frimleyblogger's avatarwindowthroughtime

freeman

Walter Jackson Freeman (1895 – 1972)

Tom Waits famously said that he’d rather have a bottle in front of me than a frontal lobotomy. Many of us like to give a piece of our mind but not in the way the latest practitioner of quackery to come under our microscope, Walter Jackson Freeman, intended.

A prominent neurologist and psychiatrist, Freeman popularised the lobotomy by making it easy and convenient. During his long career he performed 3,439 lobotomies. He was encouraged to embark upon a career performing these brutal surgical procedures when he discovered that chimpanzees became subdued when their frontal lobes were damaged, with a colleague, James Watts, he started experimenting on brains supplied by the local morgue. Freeman believed that a lobotomy was effective because it severed the connections between the frontal lobes and the thalamus of which the mentally ill were over endowed and which was thought to…

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The Elephant in the Room: Physician Suicide and Physician Health Programs

mllangan1's avatarDisrupted Physician

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Physician Suicide and the Elephant in the Room

Michael Langan, M.D.

Although no reliable statistics exist, anecdotal reports suggest an alarming upsurge in physician suicide. This necessitates a reappraisal of known predisposing risk factors such as substance abuse and depression but also requires a critical examination of what external forces or vulnerabilities might be unique to doctors and how they might be involved in the descent from suicidal ideation to suicidal planning to completed suicide.

Depression and Substance Abuse Comparable to General Population

Depression and substance abuse are the two biggest risk factors for suicide. The prevalence of depression in physicians is close to that of the general population 1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria suggest that physicians have the same rates (8-14%) of substance abuse…

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