Conflicts of interest

Carl Sagan’s Baloney Detection Kit and the Birth of “Addiction Medicine” as a New Discipline: The Need for an in Utero Diagnostic Assessment Prior to Delivery

mllangan1 13 Comments

3b67f56268909f1dfa2a168a352ad09a“One of the saddest lessons of history is this: If we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. The bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken. Once you give a charlatan power over you, you almost never get it back.”

― Carl Sagan, The Demon-Haunted World: Science as a Candle in the Dark

Carl Sagan devised a toolkit for nonsense-busting and critical thinking, which includes these nine rules:

  1. Wherever possible there must be independent confirmation of the “facts.”
  2. Encourage substantive debate on the evidence by knowledgeable proponents of all points of view.
  3. Arguments from authority carry little weight — “authorities” have made mistakes in the past. They will do so again in the future. Perhaps a better way to say it is that in science there are no authorities; at most, there are experts.2Q==
  4. Spin more than one hypothesis. If there’s something to be explained, think of all the different ways in which it could be explained. Then think of tests by which you might systematically disprove each of the alternatives. What survives, the hypothesis that resists disproof in this Darwinian selection among “multiple working hypotheses,” has a much better chance of being the right answer than if you had simply run with the first idea that caught your fancy.

  5. Try not to get overly attached to a hypothesis just because it’s yours. It’s only a way station in the pursuit of knowledge. Ask yourself why you like the idea. Compare it fairly with the alternatives. See if you can find reasons for rejecting it. If you don’t, others will.

  6. Quantify. If whatever it is you’re explaining has some measure, some numerical quantity attached to it, you’ll be much better able to discriminate among competing hypotheses. What is vague and qualitative is open to many explanations. Of course there are truths to be sought in the many qualitative issues we are obliged to confront, but finding them is more challenging.
  7. If there’s a chain of argument, every link in the chain must work (including the premise) — not just most of them.carli
  8. Occam’s Razor. This convenient rule-of-thumb urges us when faced with two hypotheses that explain the data equally well to choose the simpler.
  9. Always ask whether the hypothesis can be, at least in principle, falsified. Propositions that are untestable, unfalsifiable are not worth much. Consider the grand idea that our Universe and everything in it is just an elementary particle — an electron, say — in a much bigger Cosmos. But if we can never acquire information from outside our Universe, is not the idea incapable of disproof? You must be able to check assertions out. Inveterate skeptics must be given the chance to follow your reasoning, to duplicate your experiments and see if they get the same result.

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A November 2014 Viewpoint article in the Journal of the American Medical Association entitled Addiction Medicine: Birth of a new Discipline describes the need for “integration of addiction specialty physicians throughout the health care system” and how they plan to accomplish this. Citing the 2012 “National Survey on Drug Use and Health” findings that only 11% of Americans in need of treatment recevied it, the authors conclude that the number of addiction psychiatry diplomates (1139) is not meeting the country’s “overwhelming need for addiction specialists. To close this “addiction treatment gap” they propose “greatly expanding addiction physician specialists to include physicians from internal medicine and other specialties.”

Lax Standards

The American Society of Addiction Medicine (ASAM) only requires that you complete a residency — any residency, even dermatology or surgery — plus one year of work in the field and then 50 hours of “education.”  I took the test in 2010 and passed by a large margin without any preparation.

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Remarkably, I received my “diploma” in the mail without every meeting or speaking with anyone.   I simply paid the fee and took the test at one of the local testing centers.   This is concerning as my prior board certifications required accredited residency and training programs and were dependent on not only successfully completing those programs academically but on the reports of my superiors documentation of my character and integrity.  Screen Shot 2014-03-03 at 1.22.02 PM

With these lax standards, the ASAM have been able to create a legion of board certified addictions specialists – outnumbering psychiatrists in the field by 3 to 1.

Takeover of state Physician Health Programs (PHPs)

These ASAM “addiction experts” have become so numerous they have been able to take over almost all the state Physician Health Programs (PHPs). Their national association—the Federation of State Physician Health Programs (FSPHP)–has a stated goal of universal acceptance of the 12-step doctrine: lifelong abstinence, and spiritual recovery as the one and only treatment, as spelled out in the “PHP Blueprint.”

Very much like Straight, Inc in the 70s and 80s, they have cast a wide net with doctors to ensnare them in an endless loop of drug testing and rehab—whether the tests are fabricated or not. The doctors will enjoy no sympathy from the public, and complaining about it is deemed a sign of your “disease.”   Furthermore, ASAM recommends that physicians only be referred to “PHP approved” facilities.  

The medical directors of these facilities can all be found on this list of ”Like-Minded Docs.”  Surprisingly, many Like-Minded Docs were former addicts and alcoholics, some even with criminal backgrounds.  There are felons and even double-felons on the list.

It’s a rehab shell game. Heads I win tails you lose.

And the program is expanding. The organization that oversees the licensing for all medical doctors, the Federation of State Medical Boards, adopted a new policy and approved the concept of “potentially impairing illness” and the Orwellian notion of  “relapse without use.”

Signals for “impairment can be as benign as not having “complete accurate, and up-to-date patient medical records” according to Physician Health Services, the Massachusetts PHP.  Despite the overwhelming amount of paperwork physicians now have, incomplete or illegible records could be construed as a red flag, since as Associate Direct of PHS Judith Eaton notes “when something so necessary is not getting done, it is prudent to explore what else might be going on.” The question is, who is next?”

Not Just For Doctors, But for Everyone

Most of us are unaware of this quiet operation to police and punish our private choices. This is the New Inquisition: a move to expand this program to virtually all professions, all Americans. They want to replace the system currently being used in pilots, bus drivers, and Federal Employees with “comprehensive drug and alcohol testing” that consists of the Laboratory Developed Tests (LDTs) they introduced. Their goal is 24/7 sobriety with complete abstinence, and zero tolerance using tests of unverified validity and unknown reliability.

And they have an implementation plan.  The American Society of Addiction Medicine (ASAM), bolstered by billions of dollars from forced rehab and mandatory drug testing, has a long reach and powerful political friends. ASAM plans to force your physicians to collect your urine in the name of preventive care.

That’s right, that free preventive care you’re getting under Obamacare might soon come packaged with drug screening, as outlined in the ASAM White Paper on Drug Testing.  . Drug testing, they say, is  “vastly underutilized” throughout healthcare. The White Paper—which is well worth reading—describes the use of drug testing “within the practice of medicine and, beyond that, broadly within American Society.”

No matter your profession, if you come for a check up, you may be unwittingly looped into being referred for  “assessment” and “treatment” in a “PHP-approved” facility, where to get free, among other things, you will have to admit you are powerless and surrender to God.

If we don’t start pushing back now, soon there will be mandatory drug testing for every citizen..  A good case can be made for forced drug testing for virtually every profession –a few well-placed opeds in The New York Times and pretty soon we’ll begin to think it’s reasonable to test teachers, food handlers, you name it. They are even recruiting pediatricians to test children.      And in the new system they will not have to change your test from “forensic” to “clinical.”   A doctor-patient relationship renders the test “clinical” and by having doctors collect these specimens and calling the consequences “treatment” they can successfully use these unverified and unregulated tests introduced and marketed through a loophole into mainstream medical practice through a loophole.

One of the major goals of ASAM is recognition by the American Board of Medical Specialties. Should this occur it will inevitably lead to the end of Addiction Psychiatry and, by outnumbering them 3:1 it will be enveloped into the all encompassing field of “addiction medicine.” “Who needs two specialties?” they will argue, especially since most medical experts have accepted that addiction is a chronic relapsing “brain” disease.

And this legion of “authority” will infest our hospitals and mainstream medicine where they will join hospital formulary, ethics, research and other committees where they will be able to outnumber and outvote those of open mind and critical thought just as they did in the PHP system and the field of medicine will then be subverted to the guiding philosophy of the “impaired physicians movement.”

Addiction is a serious problem and those afflicted with it need proper assessment, diagnosis and treatment.  This illegitimate and irrational authority does not provide that.  Having had a disease does not confer authority status–I have asthma but that does not make me an expert in reactive airway disease.    Neither does interest in something, no matter how sincere, make one an expert.  I’ve had a sincere interest in science since I was a child but did not claim to be an expert in science when I was 7 because I was a member of Sir Isaac Newton’s Scientific Club.   Aside from the $2200 I had to pay and sitting through the exam gaining  ABAM certification was not all that different. This is not “expertise.”

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Prior to accepting “addiction medicine” as an ABMS approved specialty their research, tenets and basic principles of should be subjected to critical reasoning and academic analysis of the Cochrane caliber to see if they are actually valid.  This includes their claims of remarkable success in treatment and the non-FdA approved laboratory developed tests (LDTs) that they introduce.d.    The authorities and experts involved in promoting the ideology, testing and treatment should  be subject to and Institute of Medicine (IOM) conflict of interest analysis.   Who is profiting? And all of the statements, claims and suppositions regarding addiction and the guiding philosophy of the group should be subjected to Carl Sagan’s Baloney Detection kit.   If this were done the results would be failure on all three counts. False premises lead to false constructs.

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One thing is for certain. When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model.

The birth of Addiction Medicine as an ABMS accepted discipline is sure to be a success for the LDT drug and alcohol testing and 12-step assessment and treatment industry, but its spawn is sure to be an inauspicious mark on the Profession and Guild of Medicine and a bane of society for years to come.images

American Doctors Are Killing Themselves and No One Is Talking About It–By Gabrielle Glaser via the Daily Beast

mllangan1 10 Comments

Screen Shot 2015-03-23 at 7.31.40 PMVia the Daily Beast:   http://www.thedailybeast.com/articles/2015/03/23/american-doctors-are-killing-themselves-and-no-one-is-talking-about-it.html

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Excerpt:

“Doctors who acknowledge problems with substances or mental health are typically referred to a physicians health program, or PHP. These organizations evaluate, monitor, and treat physicians. Established initially in the 1970s, PHPs, which exist in almost every state, were intended to divert physicians suffering from alcohol or drug problems from censure from their state medical boards. PHPs are incorporated as nonprofits and have autonomy from the boards. But some PHPs breach confidentiality if they fear a doctor is a danger to the public. And some state medical boards also fund their PHPs. Since the boards hold the keys to licensure, many say this is a conflict of interest.

There are growing concerns about whether PHPs have the right approach to the job. They typically send doctors to rehab programs rooted in the faith-and-abstinence principles of Alcoholics Anonymous. While AA’s 12 steps might work for some with alcohol-use disorders, critics say most PHP recommendations are ill suited for patients with mental health problems.

J. Wesley Boyd, a Harvard psychiatrist who left his post as assistant director of the Massachusetts PHP over a disagreement about practices there, says PHPs routinely intimidate their clients. In an article he co-wrote for the Journal of Addictions Medicine in 2012, Boyd noted that many doctors who seek or are referred by colleagues for treatment are mandated to attend pre-selected rehabilitation facilities for 60 to 90 days. Afterward, they must agree to monitoring and drug testing, typically at their own cost. When doctors resist PHP recommendations, they risk losing their livelihood and their licenses.”

For full article see:  http://www.thedailybeast.com/articles/2015/03/23/american-doctors-are-killing-themselves-and-no-one-is-talking-about-it.html

Disrupted Physician 101.5: The American Society of Addiction Medicine (ASAM) uses (or misuses) Alcoholics Anonymous (AA)

mllangan1 8 Comments

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 The goal of the ASAM has always been to get the medical establishment to accept 12-step spiritual recovery.

AMSA evolved into the ASAM

AMSA evolved into the ASAM

According to the American Society of Addiction Medicine The ASAM Principles of Addiction Medicine is the “go-to textbook in the specialty of addiction medicine” and:

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The 4th Edition of The ASAM Principles of Addiction Medicine contains an entire section entitled “Mutual Help, Twelve Step, and Other Recovery Programs” containing three chapters entitled “Twelve Step Programs in Recovery,”1 “Recent Research into Twelve Step Programs”2 and “Spirituality in the Recovery Process.”3

Despite the all-encompassing title of this 31-page section (pages 911-942) no “other recovery programs” are described. In fact, no other programs bar 12-step ideology are even mentioned.

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I have read through each chapter word-for-word three times just to be sure; and although the chronic relapsing brain disease model of addiction requiring lifelong abstinence and spiritual recovery is described, trumpeted and proselytized in great detail, not one other model of addiction is even named.

As with anything I write I encourage you to fact-check this. My goal here is to present my opinions with facts and evidence that can be checked and verified. Point out any errors of fact and I will promptly remove and correct them. 

If a Cardiology textbook had a section entitled “Cholesterol, Statins and other Lipid Lowering Agents” with three chapters that only described Lipitor it would be correctly lambasted from every angle by the entire field of medicine as soon as it hit the shelves.

The lack of evidence-base and conflicts-of-interest would be recognized and dealt with immediately and when it was realized that many of the authors not only profited from, but  based their very own cardiac health on Lipitor they would rightly be held accountable. Such is not the case in Addiction Medicine.

The validity and reliability of opinions lie in their underlying methodology and evidence base. Reliance on the personal authority of any expert or group of experts is the fallacy of appeal to authority.

An appeal to Authority is a fallacy with the following form:

  1. Person A is (claimed to be) an authority on subject S.
  2. Person A makes claim C about subject S.
  3. Therefore, C is true

The fallacy is committed when the person (or group) in question is not a legitimate authority on the subject. If person A is not qualified to make reliable claims about subject S then the argument will be fallacious.   Since this sort of reasoning is fallacious only when the person is not a legitimate authority it is necessary that acceptable standards be set and the following standards are widely accepted.

  1. The person has sufficient expertise in the subject matter in question.
  1. The claim being made by the person is within her area(s) of expertise.
  1. There is an adequate degree of agreement among the other experts in the subject in question.
  1. The person in question is not significantly biased.
  1. The area of expertise is a legitimate area or discipline

With the exception of number 5 the ASAM fails on all counts, but policy makers, members of the press, politicians and others have been successfully bamboozled into believing the ASAM are indeed “experts” in Addiction Medicine.   imgresOver the years, the American Society of Addiction Medicine has continued to promote the AA position that alcoholism (and by inference any other addiction) is an illness which only a “spiritual experience will conquer.” All addictions are believed by ASAM to be caused by a lifelong chronic relapsing brain disorder that can only be treated by complete abstinence from all mood-altering substances (with the apparent exceptions of tobacco and caffeine interestingly) and the vast majority of ASAM doctors believe that the only effective treatment for addiction must include surrendering one’s “will and life over to the care of God.”

Because addiction is defined as a disease, addicts must be “treated” (often coerced) and “cured” (which is defined as remaining abstinent).

The medical profession needs to reexamine its role in Addiction Medicine.

Confusing ideological opinions with professional knowledge is unacceptable.   Presenting it as textbook science is not only dangerous but fosters negligence, abuse of power, self-interest and prejudice on the part of the medical community with respect to the treatment of all patients.

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To be clear, just as Lipitor may be the best treatment for some individuals with elevated cholesterol, AA and 12-step may be the best treatment for some individuals with addiction and substance use disorders. If it works for them, then more power to them. I have no problem with that.

What I do have a problem with is imposing and mandating any treatment on others.

Under a dictatorship everything else becomes subordinated to the guiding philosophy of the dictatorship.   Corresponding doctrine replaces professional guidelines, standards of care, and evidence based medicine.  And unfortunately in the case of Addiction Medicine the guiding philosophy often trumps autonomy and ethics.

Inherent in the current chronic brain disease model of addiction is the importance of external control over individuals.  Political correctness and the oversimplified medicalization of addiction is allowing it.   Demanding scientific literacy and discriminating good science from bad science would prohibit what is occurring and In order to save American Medicine this problem needs to be clearly recognized. Otherwise we will become a profession that is essentially defined by the false dichotomies and grand illusions defined by the impaired physicians movement.

  1. Schulz JE, Williams V. Twelve Step Programs in Recovery. In: Ries R, Fiellin D, Miller S, Saitz R, eds. Principles of Addiction Medicine. Baltimore: Lippincott Williams & Wilkens; 2009:911-922.
  2. McCrady BS, Tonigan GS. Recent Research into Twelve Step Programs. In: Ries R, Fiellin D, Miller S, Saitz R, eds. Principles of Addiction Medicine. 4 ed: Lippincott Williams & Wilkens; 2009:923-937.
  3. Galanter M. Spirituality in the Recovery Process. In: Ries R, Fiellin D, Miller S, Saitz R, eds. Principles of Addiction Medicine. 4 ed. Baltimore: Lippincott Williams & Wilkens; 2009:939-942.
Please donate to Disruptedphysician.com here to keep this blog running.  It is expiring in 21 days and any contribution would be appreciated.   We are making significant gains with articles such as  Physician Health Programs Under Fire .     These issues may seem small in the current turbulence, a small whirlpool in a maelstrom, but in reality they have enormous implications for all of us.  Please help out if you can-ML

 

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Wanted!–a Few Statisticians, Biostatisticians and Epidemiologists who want to make a difference in Medicine, Society and our Future

mllangan1 11 Comments
 “That everyone shall exert himself in that state of life in which he is placed, to practice true humanity towards his fellow men, on that depends the future of mankind.” – Albert Schweitzer 
“By and by never comes” –St Augustine

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“A day’s impact is better than a month of dead pull”-Justice Oliver Wendell Holmes, Jr.

 I am looking for a few honest and credible statisticians, biostatisticians or epidemiologists who want to make a difference in the spirit  of service and helping others.  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.  

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 as it did with doctors; not with a bang but a whimper.  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.”

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 forensic drug and alcohol tests and testing devices the ASAM proposes be used on the population at large utilizing the Medical Profession as a urine collection agency and bypassing forensic drug testing protocol by calling this “evaluation” and treatment rather than “monitoring” and punishment. New definitions, loopholes, secrecy and subterfuge are the bread and butter of these prohibitionist profiteers.

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 presents to medicine, our society and our future.

 Lack of Evidence-Base, Bias and Conflicts of Interest:  Making the Data Fit the Hypothesis

I am no epidemiologist or statistician but as with pornography I know junk-science when I see it.  Almost all of these tests were introduced with little or no evidence-base and, as with most of their endeavors, they did it below board via loopholes and cutting corners.

The overwhelming majority of papers are small, methodologically flawed, non-randomized, non-blinded  retrospective studies in that appear to make the data fit the hypothesis.   The authors can invariably be linked to those profiting from the tests of the testing process ( the patent holder, doctors associated with the drug testing labs, ASAM or FSPHP, Robert Dupont, Greg Skipper, etc.)

 

Ethyl Glucuronide (EtG) was introduced in 1999 as a biomarker for alcohol consumption,1 and was subsequently suggested as a tool to monitor health professionals by Dr. Gregory Skipper because of its high sensitivity to ethanol ingestion.2   

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Described as the  “innovator of EtG as an alcohol biomarker,” Skipper and  Friedrich Wurst,  “convinced” NMS labs in Pennsylvania “to start performing EtG testing in 2002.

The study most often cited as 100% proof that there is 100% accuracy in EtG testing proving alcohol consumption involved a mere 35 forensic psychiatric inpatients in Germany that was published in 2003.3  

Shortly thereafter the Physician Health Programs began using it in monitoring doctors and other professional monitoring programs soon followed.

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Up until the birth of the EtG tests used for forensic drug and alcohol monitoring had to go through the arduous, expensive and necessary FDA approval process.   The LDT pathway was designed to develop simple tests with little risk that have  low market potential (i;e. the cost of the normal FDA approval process would prohibit them from coming to market).  The LDT pathway was designed to improve patient care and help improve diagnosis and treatment. It was not designed for forensic tests.  LDT approval does not require in vivo testing.  It is essentially an honor system and to develop an LDT it is not even necessary to prove that the test is actually testing what it is purportedly testing for (validity).

So with little to no evidence base they introduced the EtG, had it developed and marketed as a LDT in collusion with unscrupulous labs, and then began using it on physicians being monitored by State PHPs. This then spread to other monitoring organizations in which there was a large power-differential between those ordering the tests and those being tested (criminal-justice, other professional monitoring programs).  These biomarkers have never been used in Federal Drug Testing, SAMHSA approved, DOT, and other organizations where unions or other organizations are present and looking out for the best interests of those being tested.

Another example of how this group removes accountability.  There has been essentially no oversight or regulation of LDTs.  Although there was a recent push for regulation of these tests the Drug and Alcohol Testing Industry Association lobby made sure that forensic tests would be exempt.

They then began publishing “research” on the EtG using the physicians being monitored as subjects. Many of the studies promoting the EtG and other biomarkers can be found  in  Journals that are linked to organizations that are linked to AA and were organized to educate the medical community.

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These small, methodologically flawed studies amount to little more than opinion pieces but   This “evidence-base” is predominantly in biased journals published by biased medical “societies.  
The EtG was subsequently found to be so sensitive that it could measure incidental exposure to alcohol in foods, over the counter cold medications, mouthwash4,5, hand sanitizer gel6, nonalcoholic beer7, and nonalcoholic wine.8  Sauerkraut and bananas have even been shown to cause positive EtG levels.9
The United States Substance Abuse and Mental Health Services Administration warned against using a positive EtG as primary or sole evidence of drinking for disciplinary or legal action.10  The Wall Street Journal in 2006 reported the problems with the EtG to the general public.11   
Screen Shot 2014-03-23 at 10.45.36 PMAs any rational authority would do, the majority of monitoring agencies abandoned the EtG after these flaws were revealed. The PHPs did not.  They continued to use the EtG on doctors uninterruptedly by telling them to avoid any products that could potentially contain alcohol; a ubiquitous substance in the environment. Since that time they have justified and rationalized (EtG)2,12 13  use by sequentially raising cutoff levels from 100 to 250 to 500 to 1000 to 2000 to now unknown and adding other LDTs as “confirmation tests such as Ethyl Sulfate (EtS)14,15 Phosphatidyl-Ethanol ( Peth)16 17 and other devices such as the Subcutaneous Remote Alcohol Monitoring Bracelet (SCRAM) and, their newest device the Cellular Photo Digital Breathalyzer (CPDB) that has recently been launched, just like the EtG Screen Shot 2014-02-23 at 10.00.22 PMwith little to no evidence base other than a pilot study done by Greg Skipper and Robert Dupont.18 
A  2013 article published in an ASAM incubated journal Alcoholism: Clinical and Experimental Research promotes the Phosphatidyl-ethanol (PEth ) test to confirm drinking.16  The study was done on physicians being monitored by the Alabama Physician Health Program who tested positive for EtG/EtS alcohol biomarkers. It is co-authored by Robert Dupont, Greg Skipper, and Friedrich Wurst and involved 18 subjects who tested positive for EtG/EtS of whom 7 claimed they did not drink.  After finding that 5 of the 7 tested negative for PEth they concluded that “positive PEth testing following positive EtG/EtS results confirms recent drinking.  Hard to wrap your head around the science in that one.Screen Shot 2014-04-30 at 1.06.53 PMSkipper is also using both Scram ankle bracelets and the CPDB monitoring in pilots in the Human Interventional Motivational Study (HIMS) Program that was developed in 2009 to “identify, treat and, eventually, re-certify airline pilots with substance abuse problems. 
 
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The Cochrane Collaboration does systematic reviews of the literature using conscientious, explicit, and judicious criteria to in order to produce and disseminate only high quality and evidenced based health care, exclude bias, and enhance transparency. The Cochrane database is a current and evolving database that includes the accuracy of diagnostic tests and is internationally recognized as the standard in evidence based health care.  This benchmark for evidence based health care and systematic reviews, records just 5 controlled trials under the topic ethyl glucuronide.8,19-21 These 5 studies represent the only high-quality evidence regarding EtG applying to EtG. Information provided by the five studies suggests the following, and only the following:

  1. EtG and EtS measurements increase with alcohol ingestion.
  2. The window of detection is shorter than what is commonly proposed (80 hours).
  3. Individual values are variable both within and between subjects.
  4. Non alcoholic wine can cause positive levels.

Notably, there are no studies that fit Cochrane Criteria, other than non-alcoholic wine, that look at the pharmacokinetics of EtG or EtS in terms of dose-response curves, cut-off levels, specificity drug and food interactions, or modes of ingestion.

SAMHSA notes that there is little research on PEth and that EtG, EtS, and PEth “do not have a strong research base,” and that “it is not known at this time how the test results might be affected by the presence of physical diseases, ethnicity, gender, time, or the use of other drugs. Until considerable more research has occurred, use of these markers should be considered experimental.”

Phosphatidylethanol (PEth), SCRAM, and the  yields no data as a test in the Cochrane library.

SAMHSA notes that there is little research on PEth and that EtG, EtS, and PEth “do not have a strong research base,” and that “it is not known at this time how the test results might be affected by the presence of physical diseases, ethnicity, gender, time, or the use of other drugs. Until considerable more research has occurred, use of these markers should be considered experimental.”

Evidence based medicine (EBM) can be defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.22

Medical progress and scientific advancement is occurring so fast that the volume of medical literature is expanding at a rate of greater than 7% per year.23

Evidence based medicine is not restricted to randomized trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions.22  

Expert opinion is the lowest level of evidence available in the EBM paradigm.24,25

Fortunately, the scientific method is a tool to help people progress toward the truth despite their susceptibilities to confirmation bias and other errors.26

Unfortunately, due to a confluence of factors (including political) this has not been done.  But, unless we want a  future as envisioned by Robert Dupont and explained in the the ASAM White Paper on Drug Testing we need to act now.  This is not a “New Paradigm” but a “New Inquisition.”

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  1. Wurst FM, Kempter C, Seidl S, Alt A. Ethyl glucuronide–a marker of alcohol consumption and a relapse marker with clinical and forensic implications. Alcohol Alcohol. Jan-Feb 1999;34(1):71-77.
  2. Skipper GE, Weinmann W, Thierauf A, et al. Ethyl glucuronide: a biomarker to identify alcohol use by health professionals recovering from substance use disorders. Alcohol Alcohol. Sep-Oct 2004;39(5):445-449.
  3. Wurst FM, Vogel R, Jachau K, et al. Ethyl glucuronide discloses recent covert alcohol use not detected by standard testing in forensic psychiatric inpatients. Alcohol Clin Exp Res. Mar 2003;27(3):471-476.
  4. Costantino A, Digregorio EJ, Korn W, Spayd S, Rieders F. The effect of the use of mouthwash on ethylglucuronide concentrations in urine. J Anal Toxicol. Nov-Dec 2006;30(9):659-662.
  5. Reisfield GM, Goldberger BA, Pesce AJ, et al. Ethyl glucuronide, ethyl sulfate, and ethanol in urine after intensive exposure to high ethanol content mouthwash. J Anal Toxicol. Jun 2011;35(5):264-268.
  6. Rosano TG, Lin J. Ethyl glucuronide excretion in humans following oral administration of and dermal exposure to ethanol. J Anal Toxicol. Oct 2008;32(8):594-600.
  7. Thierauf A, Gnann H, Wohlfarth A, et al. Urine tested positive for ethyl glucuronide and ethyl sulphate after the consumption of “non-alcoholic” beer. Forensic Sci Int. Oct 10 2010;202(1-3):82-85.
  8. Hoiseth G, Yttredal B, Karinen R, Gjerde H, Christophersen A. Levels of ethyl glucuronide and ethyl sulfate in oral fluid, blood, and urine after use of mouthwash and ingestion of nonalcoholic wine. J Anal Toxicol. Mar 2010;34(2):84-88.
  9. Musshoff F, Albermann E, Madea B. Ethyl glucuronide and ethyl sulfate in urine after consumption of various beverages and foods–misleading results? Int J Legal Med. Nov 2010;124(6):623-630.
  10. Administration SAaMHS. The role of biomarkers in the treatment of alcohol use disorders. In: Advisory SAT, ed2006:1-7.
  11. Helliker K. A test for alcohol–and its flaws. The Wall Street Journal2006.
  12. Wurst FM, Skipper GE, Weinmann W. Ethyl glucuronide–the direct ethanol metabolite on the threshold from science to routine use. Addiction. Dec 2003;98 Suppl 2:51-61.
  13. Wurst FM, Alling C, Aradottir S, et al. Emerging biomarkers: new directions and clinical applications. Alcoholism, clinical and experimental research. Mar 2005;29(3):465-473.
  14. Anton RF. Commentary on: ethyl glucuronide and ethyl sulfate assays in clinical trials, interpretation, and limitations: results of a dose ranging alcohol challenge study and 2 clinical trials. Alcoholism, clinical and experimental research. Jul 2014;38(7):1826-1828.
  15. Hernandez Redondo A, Schroeck A, Kneubuehl B, Weinmann W. Determination of ethyl glucuronide and ethyl sulfate from dried blood spots. International journal of legal medicine. Jul 2013;127(4):769-775.
  16. Skipper GE, Thon N, Dupont RL, Baxter L, Wurst FM. Phosphatidylethanol: the potential role in further evaluating low positive urinary ethyl glucuronide and ethyl sulfate results. Alcoholism, clinical and experimental research. Sep 2013;37(9):1582-1586.
  17. Hahn JA, Dobkin LM, Mayanja B, et al. Phosphatidylethanol (PEth) as a biomarker of alcohol consumption in HIV-positive patients in sub-Saharan Africa. Alcoholism, clinical and experimental research. May 2012;36(5):854-862.
  18. Skipper GE, Thon N, DuPont RL, Campbell MD, Weinmann W, Wurst FM. Cellular photo digital breathalyzer for monitoring alcohol use: a pilot study. European addiction research. 2014;20(3):137-142.
  19. Hoiseth G, Bernard JP, Stephanson N, et al. Comparison between the urinary alcohol markers EtG, EtS, and GTOL/5-HIAA in a controlled drinking experiment. Alcohol Alcohol. Mar-Apr 2008;43(2):187-191.
  20. Wojcik MH, Hawthorne JS. Sensitivity of commercial ethyl glucuronide (ETG) testing in screening for alcohol abstinence. Alcohol Alcohol. Jul-Aug 2007;42(4):317-320.
  21. Sarkola T, Dahl H, Eriksson CJ, Helander A. Urinary ethyl glucuronide and 5-hydroxytryptophol levels during repeated ethanol ingestion in healthy human subjects. Alcohol Alcohol. Jul-Aug 2003;38(4):347-351.
  22. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. Jan 13 1996;312(7023):71-72.
  23. Norwitz ER, Greenberg JA. Promoting evidence-based medicine. Rev Obstet Gynecol. Summer 2008;1(3):93-94.
  24. Shaneyfelt TM, Centor RM. Reassessment of clinical practice guidelines: go gently into that good night. JAMA. Feb 25 2009;301(8):868-869.
  25. Straus SE, Green ML, Bell DS, et al. Evaluating the teaching of evidence based medicine: conceptual framework. BMJ. Oct 30 2004;329(7473):1029-1032.
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Reliability of hair drug tests up for debate

mllangan1 7 Comments

“The hardest thing to explain is the glaringly evident which everybody has decided not to see”

― Ayn Rand, The Fountainhead

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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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The LDT Pathway was not designed for Forensic Drug and Alcohol Testing.  It is an Unregulated Industry.

The LDT pathway was developed for laboratory tests that would not otherwise come to market due to the prohibitive costs of FDA approval (for example a test for a rare disease).

Bringing an LDT to market does not require testing in humans (in vivo). Nor does it require that it be shown the test is testing for what it is purportedly testing for (validity). It is essentially an honor system. It was not designed for “forensic” testing but for simple testing with low risk.

None of this testing is approved by the FDA. It is essentially an unregulated industry.

NMS became a leading proponent of EtG testing and, starting in 2003, began publishing claims promoting the absolute validity and reliability of the EtG in detecting alcohol. Akin to the vitamin and supplement industry those promoting and selling the tests could say anything they want—and they did.

NMS initially established a reporting limit or cutoff of 250ng/ml at or over which EtG test results would be reported as “positive” for drinking alcohol. This was later upped to 500ng/ml, then 1000 ng/ml.

NMS reported it as the “Gold Standard” claiming any value above 250 ng/ml indicated “ethanol consumption.”

It was subsequently found to be so sensitive that it could measure incidental exposure to alcohol in foods, over the counter cold medications, mouthwash4,5, hand sanitizer gel6, nonalcoholic beer7, and nonalcoholic wine.8

As the cutoff value got higher they added another minor metabolite of alcohol, EtS, as a “confirmatory” LDT.

The authors of a 2011 study demonstrating that hand sanitizer alone could result in EtG and EtS concentrations of 1998 and 94 mug/g creatinine concluded that:

“in patients being monitored for ethanol use by urinary EtG concentrations, currently accepted EtG cutoffs do not distinguish between ethanol consumption and incidental exposures, particularly when uine specimens are obtained shortly after sustained use of ethanol containing hand sanitizer.”9

Sauerkraut and bananas have even recently been shown to cause positive EtG levels.10

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A 2010 study found that consumption of baker’s yeast with sugar and water11 led to the formation of elevated EtG and EtS above the standard cutoff. EtG can originate from post-collection synthesis if bacteria is present in the urine.12 Collection and handling routines can result in false-positive samples.13

EtG varies among individuals.14 Factors that may underlie this variability include gender, age, ethnic group, and genetic polymorphisms.

“Exposure to ethanol-containing medications, of which there are many, is another potential source of “false” positives.15

Problems Exposed by Wall Street Journal and SAMHSA

On August 12, 2006, The Wall Street Journal published a front-page article, titled “A Test for Alcohol – And Its Flaws.”.16

Quoting Dr. Skipper, among others, the article includes:

“Little advertised, though, is that EtG can detect alcohol even in people who didn’t drink. Any trace of alcohol may register, even that ingested or inhaled through food, medicine, personal-care products or hand sanitizer.”

“The test ‘can’t distinguish between beer and Purell’ hand sanitizer, says H. Westley Clark, director of the Federal Substance Abuse and Mental Health Services Administration. . . ‘When you’re looking at loss of job, loss of child, loss of privileges, you want to make sure the test is right”, he says…”

“Use of this screen has gotten ahead of the science,’ says Gregory Skipper…”

Methinks Dr. Skipper might have realized this when he initially proposed it as an accurate test after a pilot study done on only a handful of subjects. Or perhaps when he used the LDT pathway to bypass FDA approval and oversight.

On September 28, 2006, SAMHSA, a federal agency that is part of the U.S. Department of Health and Human Resources, issued an Advisory, which on the first page contained a “grey box” warning, as follows:

Unknown-20“Currently, the use of an EtG test in determining abstinence lacks sufficient proven specificity for use as primary or sole evidence that an individual prohibited from drinking, in a criminal justice or a regulatory compliance context, has truly been drinking. Legal or disciplinary action based solely on a positive EtG, or other test discussed in this Advisory is inappropriate and scientifically unsupportable at this time. These tests should currently be considered as potential valuable clinical tools, but their use in forensic settings is premature.”17

Bias has been identified as a large problem with drug trials.18   Industry-sponsored research is nearly four times as likely to be favorable to the company’s product as NIH-sponsored research.19 As an example, one survey of seventy articles about the safety of Norvasc (amlodipine) found that 96% of the authors who were supportive of the drugs had financial ties to the companies that made them.20

But what about the multi billion dollar drug-testing industry and the financial ties here?Screen Shot 2014-02-23 at 7.52.29 PM

Imagine if this was a drug and not a drug-test.

Essentially Greg Skipper and the FSPHP arm of ASAM launched a very lucrative joint business venture with a commercial drug-testing lab. They introduced the test via a loophole as a laboratory developed test.  An LDT has no FDA regulation so the lab was able to promote, market and sell these tests with no meaningful oversight or accountability.  Quest Diagnostics and USDTL are now working with the FSPHP and engaging in the same scheme.

The lab then contracted with state licensing boards and their state PHPs (who designed, implemented and managed drug and alcohol testing programs for nurses and doctors).   A mutually beneficial scheme for the labs (who collect the samples) and the PHPs (who utilize, interpret and report the results.

The PHPs develop the arbitrary cutoff levels based on alleged “scientific” research and the labs promote whatever they say. “Gold-Standard,” “accurate” and “reliable.”  Screen Shot 2014-02-23 at 3.12.12 PM

EtG, EtS, Scram, PEth, Soberlink–all unsupported junk science introduced by prohibitionist profiteers without conscience.

How many lives were ruined by this test?   How many careers were lost, families shattered and futures erased. I would venture to say a lot. Just look through all of the legal cases as I have. It is unconscionable. Sociopathic profiteering.

How many committed suicide feeling helpless, hopeless and entrapped?

At the end of a talk entitled  Addicted Professionals: intervention, Evaluation and Treatment, Skipper presents a slide reading “Reporting or Assisting a Troubled Peer?  These doctor’s can’t help themselves….” followed by graphic images of physician suicide.   (see torrance_meeting_2 (4) ).    It is for shock value and morbid humor and it is grotesque.   He could not care less that these were human beings with wives, husbands, children and hopes and dreams.

How many scenes like this were repeated across the country because this guy gamed the system to get an ultra-sensitive test with abysmal specificity for a ubiquitous organic compound approved and marketed as a “forensic” test?

Forensic testing needs to be as close to 100% specific as possible because the results of a positive test can be grave and far reaching.   Getting this test (and all the others) approved and marketed through a loophole and then getting the state Boards and Federation of State Medical Boards to approve them by moral entrepreneurship is unconscionable.    Using the LDT pathway is just another example of how the “impaired physician movement” removes accountability and culpability by bending, ignoring or otherwise making their own rules.

And the labs have taken a “stand your ground” approach. Never admit wrongdoing. Never settle.Screen Shot 2014-02-23 at 10.00.22 PM

In a February 2007 article in the magazine “New Scientist,” Dr. Skipper is quoted

that:

“…there is not yet an agreed threshold concentration that can be used to separate people who have been drinking from those exposed to alcohol from other sources. Below 1000 nanograms of EtG per millilitre of urine is probably ‘innocent’, and above 5000 booze is almost certainly to blame. In between there is a “question zone…”Unknown-12

No Dr. Skipper—it is you who is most certainly to blame. And what of all the people whose lives you ruined by introducing junk science with no evidence base via a regulatory loophole?? “probably innocent?”   Shame on you Dr. Skipper…. Shame..shame..shame.Screen Shot 2014-02-23 at 10.00.10 PM

 

  1. Bean P. State of the art contemporary biomarkers of alcohol consumption. MLO Med Lab Obs. Nov 2005;37(11):10-12, 14, 16-17; quiz 18-19.
  2. Wurst FM, Kempter C, Seidl S, Alt A. Ethyl glucuronide–a marker of alcohol consumption and a relapse marker with clinical and forensic implications. Alcohol Alcohol. Jan-Feb 1999;34(1):71-77.
  3. Skipper GE, Weinmann W, Thierauf A, et al. Ethyl glucuronide: a biomarker to identify alcohol use by health professionals recovering from substance use disorders. Alcohol Alcohol. Sep-Oct 2004;39(5):445-449.
  4. Costantino A, Digregorio EJ, Korn W, Spayd S, Rieders F. The effect of the use of mouthwash on ethylglucuronide concentrations in urine. J Anal Toxicol. Nov-Dec 2006;30(9):659-662.
  5. Reisfield GM, Goldberger BA, Pesce AJ, et al. Ethyl glucuronide, ethyl sulfate, and ethanol in urine after intensive exposure to high ethanol content mouthwash. J Anal Toxicol. Jun 2011;35(5):264-268.
  6. Rosano TG, Lin J. Ethyl glucuronide excretion in humans following oral administration of and dermal exposure to ethanol. J Anal Toxicol. Oct 2008;32(8):594-600.
  7. Thierauf A, Gnann H, Wohlfarth A, et al. Urine tested positive for ethyl glucuronide and ethyl sulphate after the consumption of “non-alcoholic” beer. Forensic Sci Int. Oct 10 2010;202(1-3):82-85.
  8. Hoiseth G, Yttredal B, Karinen R, Gjerde H, Christophersen A. Levels of ethyl glucuronide and ethyl sulfate in oral fluid, blood, and urine after use of mouthwash and ingestion of nonalcoholic wine. J Anal Toxicol. Mar 2010;34(2):84-88.
  9. Reisfield GM, Goldberger BA, Crews BO, et al. Ethyl glucuronide, ethyl sulfate, and ethanol in urine after sustained exposure to an ethanol-based hand sanitizer. J Anal Toxicol. Mar 2011;35(2):85-91.
  10. Musshoff F, Albermann E, Madea B. Ethyl glucuronide and ethyl sulfate in urine after consumption of various beverages and foods–misleading results? Int J Legal Med. Nov 2010;124(6):623-630.
  11. Thierauf A, Wohlfarth A, Auwarter V, Perdekamp MG, Wurst FM, Weinmann W. Urine tested positive for ethyl glucuronide and ethyl sulfate after the consumption of yeast and sugar. Forensic Sci Int. Oct 10 2010;202(1-3):e45-47.
  12. Helander A, Olsson I, Dahl H. Postcollection synthesis of ethyl glucuronide by bacteria in urine may cause false identification of alcohol consumption. Clin Chem. Oct 2007;53(10):1855-1857.
  13. Helander A, Hagelberg CA, Beck O, Petrini B. Unreliable alcohol testing in a shipping safety programme. Forensic Sci Int. Aug 10 2009;189(1-3):e45-47.
  14. Sarkola T, Dahl H, Eriksson CJ, Helander A. Urinary ethyl glucuronide and 5-hydroxytryptophol levels during repeated ethanol ingestion in healthy human subjects. Alcohol Alcohol. Jul-Aug 2003;38(4):347-351.
  15. Jatlow P, O’Malley SS. Clinical (nonforensic) application of ethyl glucuronide measurement: are we ready? Alcohol Clin Exp Res. Jun 2010;34(6):968-975.
  16. Helliker K. A test for alcohol–and its flaws. The Wall Street Journal2006.
  17. Administration SAaMHS. The role of biomarkers in the treatment of alcohol use disorders. In: Advisory SAT, ed2006:1-7.
  18. Bodenheimer T. Uneasy alliance–clinical investigators and the pharmaceutical industry. N Engl J Med. May 18 2000;342(20):1539-1544.
  19. Bekelman JE, Li Y, Gross CP. Scope and impact of financial conflicts of interest in biomedical research: a systematic review. JAMA. Jan 22-29 2003;289(4):454-465.
  20. Stelfox HT, Chua G, O’Rourke K, Detsky AS. Conflict of interest in the debate over calcium-channel antagonists. N Engl J Med. Jan 8 1998;338(2):101-106.

 

 

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The High PROFITS of the 12 Step Cult Religion and Bain Capital

mllangan1 7 Comments

“The belief that there are such things as witches is so essential a part of the faith that obstinately to maintain the opposite opinion manifestly savors of heresy.”

So begins Malleus Maleficarum , a witch hunters manual published in 1486 that launched a new paradigm for all those concerned with the identification and extirpation of witches. Used as a judicial case-book the Malleus set forth definitions of witchcraft, rules of evidence and the canonical procedures by which suspected witches were tortured and put to death. Written by Inquisitors for Inquisitor, the Malleus construct came to be regarded as irrefutable truth and contributed to the identification and execution of as many as 60,000 “witches”, predominantly women. The 29th and last edition was published in 1669.

Because of the nature of the enemy the evidentiary standard was lowered and any witness, no matter what his credentials, could testify against the accused.

Using the nebulous “witch label” anyone with a grudge or suspicion could accuse anyone of witchcraft .

From the 15th century through the early 17th century a confederacy of “authorities” calling themselves “demonologists” existed and made money off the misery of others.

Identification of witches was detailed in the Malleus including both physical and behavioral clues. Physical signs included things such as bushy eyebrows and thin lips. The Malleus declared that witches have a “Devil’s mark (stigmata diaboli) or Devils seal (sigilum diaboli) which was usually a scar, birthmark, or blemish. An extra nipple (polythelia) was a tell-tale sign. Behavioral manifestations included living alone, cultivating strange herbs in the garden, public singing or dancing and saying hello to a neighbors cat.

Physician oversight of witch persecution was standard.  So too was the involvement of “witch-prickers” who were able to provide their expertise and “medical” testing in the assessment and diagnosis of the witch.

Pricking them with needles, awes, and bodkins to prove they were indeed nefarious and non-human was a surefire way to line one’s pockets but for the pedophiles and pervs there was an added bonus—a thorough searching for that stigmata diaboli on someone else’s dime.

Through the witch trials clerics, doctors, and lawyers used their expertise as witnesses to increase their prestige. Witch hunts developed into a means of economic profit. Some gained a lot of money from the witch trials. The witch or her relatives paid for the salaries of those who worked the witch trials including judges, court officials, torturers, physicians, clergymen, scribes, guards, attendants.

Even the people who made the stakes and scaffolds for executions gained from the conviction and death of each witch.

“Witch hunting,” wrote the historian Rossell Hope Robbins, “was self-sustaining and became a major trade, employing many people, all battening on the savings of the victims.” The costs of a witch trial were usually paid for by the estate of the accused or their family.

And what my friend Laura Tompkin’s describes here in no different; except in place of “demonologists” we now have “addictionologists.”

Both faulty paradigms with a lot of people making money hand over fist.

In 1592 Father Cornelius Loos wrote:

“Wretched creatures are compelled by the severity of the torture to confess things they have never done and so by cruel butchery innocent lives are taken; and by new alchemy, gold and silver are coined from human blood.”

And this is no different. No different at all.

12 Step Cult Religion Exposed

The following article will educate you on the annual profits made by the 12 step industry.  Whenever steppers claim that their cult is free, you now have proof that it is most certainly not in any way, shape or form, free.  Just because people are too lazy, ignorant and/or brainwashed, is no excuse for perpetuating dangerous lies.  Please note that anything in parentheses is my addition and anything bolded is also mine.  This author is misinformed, as is the general public, and classifies alcohol disorders as diseases.  However, this misinformation does not disqualify the facts here about rehab profits and Bain Capital.

Bain Capital’s grip on addiction – The profit of 12-step treatment

By Jamie Wendland

Last year nearly 2.5 million people 12 years of age or older sought treatment for substance abuse in the U.S., according to the National Survey on Drugs and Health. 2.3 million Americans…

View original post 1,696 more words