Where have you gone, Morris Fishbein? Our nation turns its lonely eyes to you.

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I count no man a Philosopher who hath not, be it before the court of his Conscience or at the assizes of his Intellect, accused himself of a scurrilous Invention, and stood condemned by his own Judgement a brazen Charlatan.’
      Robert Burton, The Anatomy of Melancholy (1621)

Morris Fishbein M.D. (July 22, 1889 – September 27, 1976) was the editor of the Journal of the American Medical Association (JAMA) from 1924 to 1950 and in 1961 became the founding Editor of Medical World News, a magazine for doctors. In 1970 he endowed the Morris Fishbein Center to encourage the study of the history of science and medicine.

Fishbein  was also notable for exposing quacks such as  John Romulus Brinkley, a physician (in the diploma-mill sense of the word–he paid $500 for diploma he purchased from the Eclectic Medical University of Kansas City, Missouri) who in 1917 pioneered the notion of the goat testicle “transplant” as treatment for erectile dysfunction. The procedure involved removing the testicles of young goats and sewing them to the abdominal walls and scrotal tissues of men without any attempt to connect either the nerves or blood vessels of the “grafted” tissues.

Clinically useless, Brinkley made a fortune over the next decade through his goat gonad rejuvenation procedure.  Although he never finished his degree at Bennett Medical College in Chicago (where he left after his third year) and often operated while inebriated, Brinkley became one of the most famous doctors in the United States.  He claimed that his procedure cured 27 ailments including emphysema, acne and obesity.   It didn’t cure or even impact any of them.    What planting goat parts into people did do was solely self-serving.  It lined  Brinkley’s pockets and fed his ego and in doing so killed a lot of patients.  His operation was often lethal.

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Dr. John, R. Brinkley

Throughout his career this phony surgical grifter found himself incessantly challenged by Quack-buster extraordinaire Dr. Morris Fishbein.  Relentless in his pursuit of exposing the fakery, fraud and pseudoscience of this charlatan and quack, he eventually succeeded.

I am well aware of the criticisms of Dr.Fishbein–many are valid, some are exaggerated and some are utter nonsense.  He was, after all, human.

That being said, however, in the final rendering  Dr. Morris Fishbein left the profession of medicine a better place for having been here.  The same cannot be said of Dr. John R. Brinkley.

Similarly, the same cannot be said of Dr. Henry Andrews Cotton, M.D.,  (1876 – May 1933) a psychiatrist and Medical Director of New Jersey State Hospital at Trenton who used the emerging medical theory of infection-based psychological disorders to pull patient’s teeth under the premise they were suspected of harboring infections.  If this failed he subsequently removed the tonsils, sinuses, testicles, ovaries, gallbladders, stomachs, spleens, and cervixes of his patients. If these maneuvers failed Cotton then went for the colon–with special emphasis on the right side of the hindgut, which, he declared, had particularly ”decadent tendencies.”

From 1907 to 1930 he killed hundreds of patients and maimed many more.  Cotton reported cure rates as high as 85%. His fame in the U.S. spread rapidly and it took decades before his alarmingly high post-operative death rate of over 30% (mostly from peritonitis) raised any red flags.

Illustration of a mouth with teeth removed from Cotton's book The defective delinquent and insane: the relation of focal infections to their causation, treatment and prevention.

Illustration of a mouth with teeth removed from Cotton’s book The defective delinquent and insane: the relation of focal infections to their causation, treatment and prevention.

The same can also not be said of  Dr, Walter Jackson Freeman II, M.D. (November 14, 1895 – May 31, 1972), a neurologist without surgical training who pioneered the ice-pick lobotomy in the U.S.. and performed nearly 3500 of them in 23 states.  Seeking a faster way to perform the procedure, Freeman adopted Amarro Fiamberti’s transorbital lobotomy and perfected it by using ice picks hammered into the frontal lobes through the back of each eye socket.   Without anesthesia he was able to do these procedures  quickly and outside the operating room.   And in doing so he popularized the lobotomy in the U.S..  I’ve seen the results of Freeman’s work.  During a workup of a patient who I was consulting on for dementia an MRI revealed bilateral atrophic genu of the corpus callosum.   The patient and his family initially denied any history of prior brain surgery or injury but on further questioning recalled having something done to him in college that left him with two black eyes.  He said he was suffering from depression over his final exams and this was done to him at the student medical clinic during the same time frame Freeman was traveling to college campuses in his lobotomobile offering his services.   Neither the patient nor his family realized he had had a lobotomy.  Many of Freeman’s victims were children as young as 12.

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Dr. Freeman and his “lobotomobile”

The Medical Follies

The following quotes are taken from The Medical Follies, by  Dr. Morris Fishbein. He writes:

“Folly in the singular is recorded as weakness of intellect, foolishness, imbecility, etc. But in the plural, whatever it may retain of the singular, it has taken upon itself a new glory. ‘The Follies,’ after two decades of association with the theater, have come to mean entertainment—a spectacle, bright, flashing, exotic, devoid of plot, nude of truth and easy to enjoy except by those to whom still adheres some early piety.

“The incompetent or unprincipled physician, licensed to practice medicine by a too complaisant State is the greatest menace to scientific medicine – as great a menace as all the cultists put together.”

“Now, scientific medicine offers no such system. It aims, by the utilization of all available knowledge, to determine the cause of disease, and then, by the use of all intelligent methods, to benefit and heal the disease. It does not promulgate any theory or principle to the exclusion of established facts. It does not say, for example, that all disease arises in the spine and all disease can be healed by manipulating the spine….”

“The great fallacy of all the ‘systems’ of disease and their healing lies in this ‘all or nothing’ policy. When that policy runs counter to demonstrable facts the result is invariably disaster.”

What do Brinkley, Cotton and Freeman all have in common?  They all gained public recognition and became rich from what they did, Scarcely anyone doubted them publicly in the medical profession,  and they all practiced unmitigated and unmolested murder for decades before any red flags were raised.  In all likelihood all three were also sociopaths.

In the final rendering  Dr. Morris Fishbein left the profession of medicine a better place for having been here.  Brinkley, Cotton and Freeman most assuredly did not.  Sociopaths seldom do.

Junk-Science in the Medical Profession: The Resurgence of Polygraph “Lie-Detection” in an age of Evidence-Based Medicine

Disrupted Physician

33755_1527129670651_5081648_n Circa 1995

The article below was published in the now defunct magazine Gray Areas almost twenty years ago. (Vol. 4, No. 1, Spring 1995 pp. 75-77).   Antipolygraph.og founder George Maschke noted in 2008 that article “makes a good introduction to the pseudoscience of polygraphy” and “the criticisms of polygraphy remain valid today.”  They remain valid in 2014.

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The Art of Deception: Polygraph Lie Detection

By Michael Lawrence Langan, M.D.

I’d swear to it on my very soul, If I lie, may I fall down cold.”

– Rubin and Cherise
(Hunter/Garcia)

The accuracy of polygraphic lie detection is slightly above chance. Nevertheless, State and local police departments and law enforcement agencies across the United States are devoted proponents of this unscientific and specious device. In addition, the American public seems to lend an implicit credence to the “lie detector” as evinced by its ubiquitous use on television crime shows and…

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When to Doubt a Scientific Consensus

The 12-red flags below are very applicable to American Society of Addiction Medicine (ASAM) related consensus and public policy.    When viewed through this lens the science and research all falls apart.

(1) When different claims get bundled together.
(2) When ad hominem attacks against dissenters predominate.
(3) When scientists are pressured to toe the party line.
(4) When publishing and peer review in the discipline is cliquish.
(5) When dissenting opinions are excluded from the relevant peer-reviewed literature not because of weak evidence or bad arguments but as part of a strategy to marginalize dissent.
(6) When the actual peer-reviewed literature is misrepresented.
(7) When consensus is declared hurriedly or before it even exists.
(8) When the subject matter seems, by its nature, to resist consensus.
(9) When “scientists say” or “science says” is a common locution.
(10) When it is being used to justify dramatic political or economic policies.
(11) When the “consensus” is maintained by an army of water-carrying journalists who defend it with uncritical and partisan zeal, and seem intent on helping certain scientists with their messaging rather than reporting on the field as objectively as possible.
(12) When we keep being told that there’s a scientific consensus.

Peddling Fiction

  • Anyone who has studied the history of science knows that scientists are not immune to the non-rational dynamics of the herd. Many false ideas enjoyed consensus opinion at one time. Indeed, the “power of the paradigm” often shapes the thinking of scientists so strongly that they become unable to accurately summarize, let alone evaluate, radical alternatives. Question the paradigm, and some respond with dogmatic fanaticism.
  • So what’s a non-scientist citizen, without the time to study the scientific details, to do? How is the ordinary citizen to distinguish, as Andrew Coyne puts it, “between genuine authority and mere received wisdom? Conversely, how do we tell crankish imperviousness to evidence from legitimate skepticism?” Are we obligated to trust whatever we’re told is based on a scientific consensus unless we can study the science ourselves? When can you doubt a consensus? When should you doubt it?
  • Your best bet is to look at…

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

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

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

“THIS WHITE PAPER ENCOURAGES WIDER AND “SMARTER” USE OF DRUG TESTING WITHIN THE PRACTICE OF MEDICINE AND, BEYOND THAT,BROADLY WITHIN AMERICAN SOCIETY. SMARTER DRUG TESTING MEANS INCREASED USE OF RANDOM TESTING* RATHER THAN THE MORE COMMON SCHEDULED TESTING,* AND IT MEANS TESTING NOT ONLY URINE BUT ALSO OTHER MATRICES SUCH AS BLOOD, ORAL FLUID (SALIVA), HAIR, NAILS, SWEAT AND BREATH WHEN THOSE MATRICES MATCH THE INTENDED ASSESSMENT PROCESS. IN ADDITION, SMARTER TESTING MEANS TESTING BASED UPON CLINICAL INDICATION FOR A BROAD AND ROTATING PANEL OF DRUGS RATHER THAN ONLY TESTING FOR THE TRADITIONAL FIVE-DRUG PANEL.”

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

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

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

And that is why I am asking for help from statisticians, biostatisticians and epidemiologists.  The task would entail a review of the literature prior to the introduction of these tests for evidence base of forensic applicability (there essentially is none) and a review of the literature peri-and post marketing of these devices to assess the reliability and credibility of the underlying methodology and ascertain the evidence-base.  The goal would be publication in both academic journals and presentation to the general public through media publication with the assistance of investigative journalists and other writers. The goal is to get the truth out about these tests and allow both the medial profession and public at large to awaken to the menace this represents.
 I can’t pay you but you would be combating injustice, corruption and dishonesty.   You would be doing your part in helping the Medical Profession, honest and decent doctors, our country and  perhaps our future.  

Science vs. Pseudoscience

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Disrupted Physician 101.1: The “Impaired Physician Movement” and the History of the American Society of Addiction Medicine (ASAM)

Disrupted Physician 101.1: The “Impaired Physician Movement” and the History of the American Society of Addiction Medicine (ASAM).

Henry David Thoreau

“With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world.”—Twelve Steps and Twelve Traditions, AA World Services, Inc (1953).

In 1985 the British sociologist G. V. Stimson wrote:

“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.”

The American Society of Addiction Medicine’s mission is to “establish addiction medicine as a specialty recognized by professional organizations, governments, physicians, purchasers, and consumers of health care products, and the general public.”  

In this they have succeeded.images-4

And in the year 2014 Stimson’s characterization of the “impaired physician movement” remains as accurate and apt as it was in 1985. But the “number of evangelical recovered alcoholic and addict physicians” has increased dramatically  (outnumbering Addiction Psychiatry by 4:1)  and their involvement in  medical society and treatment programs” has been realized and enforced through the state Physician Health Programs and their “PHP-approved’ assessment and treatment centers.

Their “ability to make authoritative pronouncements on physician impairment…based on their own claim to insider’s knowledge”  has become public policy and sanctified by Regulatory Medicine -essentially the Word of the Lord.

And the 1953 Alcoholics Anonymous prophecy that “With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world” is also coming to pass.

But the world is not changing for the better as that arm around the shoulder of religion has its fingers deep in the pockets of the multi-billion dollar drug and alcohol testing and assessment and treatment industries.  And the arm around the shoulder of medicine has its fingers clamped tightly around its throat; a stranglehold in full throttle suffocating the Profession of Medicine with no meaningful opposition I can see.