Monopolies, Self-Referral and Shell Games: The Need for Antitrust Investigation of Physician Health Programs and their “PHP-Approved” Assessment and Treatment Centers

June 8, 2015June 8, 2015mllangan1 6 Comments

On the above list can be found the Medical Directors of a number of drug and alcohol rehabilitation facilities. I did not make up this list. An updated version can be seen right here on the “like-minded doc” website.

Talbott, Marworth, Hazelden, Promises, and another two-dozen or so “PHP-approved” assessment and treatment centers are represented on this list. State Physician Health Programs (PHPs) refer doctors to these facilities for evaluations. PHPs are non-profit tax-exempt organizations. They do not evaluate or treat patients. If a physician is referred to a PHP for a suspected problem the assessment must be done at an outside facility which will invariably be linked to a name on the list of Like-Minded Docs.

What most people do not know, however, is that this is an exclusive arrangement. Evaluations are constrained to one of these facilities. It is mandated. No bargaining. No compromises. No choice. In other words it is a coercion.

Disrupted Physician

Three shells and a pea–ASAM, FSPHP, and LMD.

“PHP-Approved” Assessment and Treatment Centers

On the above list can be found the Medical Directors of a number of drug and alcohol rehabilitation facilities. I did not make up this list. An updated version can be seen right here on the “like-minded doc” website.

Talbott, Marworth, Hazelden, Promises, and another two-dozen or so “PHP-approved” assessment and treatment centers are represented on this list. State Physician Health Programs (PHPs) refer doctors to these facilities for evaluations. PHPs are non-profit tax-exempt organizations. They do not evaluate or treat patients. If a physician is referred to a PHP for a suspected problem the assessment must be done at an outside facility which will invariably be linked to a name on the list of Like-Minded Docs.

What most people do not know, however, is that this is an exclusive arrangement. Evaluations are constrained to one of these facilities…

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Beyond the Schoolyard: Workplace Bullying

June 8, 2015June 8, 2015mllangan1 59 Comments

This infographic on workplace bullying was created by International Business Degree Guide to convey the message that workplace bullies not only hurt people, they can also hurt business–driving away good employees in their quest for control.

Adept at dissimulation, those in authority often see what the bully expressly feigns and pretends to be. Under observation by authority the bully hides his true self and often cultivates an image designed to please and impress.

Veiling truth to those in power protects the bully. Reports of abuse are disbelieved or ignored; dismissed or minimized as exaggeration; deemed a product of bellyachers and whiners. In addition to hiding his true self the bully will often tell superiors what they want to hear. The workplace bully promotes an image of loyalty, dedication and hard work to superiors and may even feign common ideals and goals. This impression management often works.

When bullying ends in tragedy it is often revealed that those who could and should have done something about it knew about it and did nothing. This failure to act may be the result of blinkered apathy, willful ignorance and even malicious complicity. This is especially true when the political and ideological views of the bully align closely with those in charge and the victim of bullying is remotely aligned. Moral superiority, bigotry, racism, and other biases all too often factor into the equation.

Perhaps those without sufficient empathy of others to take action when reports of abuse and harassment are reported to them will do their jobs if they realize workplace bullying might harm them personally or what they value most.

via Beyond the Schoolyard: Workplace Bullying.

Snakes in Smocks: Unrecognized Corporate Psychopathy in the Medical Profession

May 30, 2015September 28, 2015mllangan1 13 Comments

A 2010 study, Corporate Psychopathy: Talking the Walk, found that 3 to 6 percent of corporate employees may be responsible for the majority of ethical breaches in corporations, with corporate psychopathy tending to be concentrated at the higher levels of organizations.

This group here, Like-minded Docs, is largely responsible for what happens to any doctor referred to a state PHP because all of the medical directors of the “PHP-approved” assessment and treatment centers can be found right here.

So too can Bob Dupont and Greg Skipper who have introduced the non-FDA approved drug and alcohol LDTs. Stuart Gitlow, President of ASAM is also on the list.

This group is essentially in control of doctors and determines their fates and the percentage of psychopathy here is much much more than the 3-6% found at Enron.

Some of these doctors have done horrible things that most doctors would never do under any circumstances (steal IV pain relieving drugs from dying cancer patients I.V. bags, selling the ‘date-rape” drug to DEA agents).

On this list are multiple felons and a fair number of double felons who got their licenses back by saying they were not responsible for what they did. They were helpless over drugs or alcohol and have now been saved by the good graces of 12-step spirituality.

And with that the medical boards gave them power without accountability. There is no regulation, oversight, answerability or need to justify their actions. It is a free for all and this list is a gold-mine for anyone studying organized psychopathy.

Physician Health Programs are a funnel for the sociopath and without restraint they are only growing.

This is what John Nash described would happen without counter-forces to keep their numbers low.

Psychopathy

Psychopathy is present in all professions. In The Wisdom of Psychopaths: What Saints, Spies, and Serial Killers Can Teach Us About Success, Kevin Dutton provides a side-by-side list of professions with the highest (CEO tops the list) and lowest (care-aid) percentage of psychopaths. Interestingly surgeons come in at #5 among the professions with the highest percentage of psychopathy while doctors (in general) are listed among the lowest.

Although by no means a scientific study, Psycopaths, by their very nature, seek power and it would make sense that a psychopath among us might pick surgery over pediatrics or pathology as they are drawn to power, prestige, and control. Be this as it may the incidence of psycopathy or psychopathic traits in doctors of any specialty is low. Statistics indicate that no more than 1% of men in general exhibit psychopathic traits. In Women these characteristics are far less.

Due to irresponsible behavior and a tendency to ignore or violate social conventions and rules, psychopaths frequently find themselves engaged in conduct involving the criminal justice system or involved in other disciplinary action. Juvenile delinquency, arrests, school suspensions and misconduct related issues are barriers that preclude professional careers for many and, with around 15% of the prison population estimated to be psychopathic, incarceration and recidivism are common final pathways. Because of this tendency it would be highly unlikely for most sociopaths to follow a standard professional career pathway involving academic rigor and normal professional and societal expectations, because impulsive irresponsible actions commonly blocks it. This would predict a probably much lower prevalence of psycopathy in physicians compared to the general population.

That being said, such self imposed removal from a potential career is the sole product of getting caught for misconduct and being held accountable for it. Psychopaths possess several traits that make this difficult. With a talent for “reading people” and identifying their weak spots and vulnerabilities they are able to get people to see what they want them to see. Psychopaths often exude charm, confidence and charisma. They can lie effortlessly and are very convincing..

The natural history of psychopathy involves risky behavior and the ability to get away with it or out of it. The consequences of this depend on if and when it occurs. It is entirely conceivable that some may live their entire lives undetected. With a need for stimulation and a proneness to boredom the psychopath is particularly prone to drug abuse and addiction and twice as likely as the general population to be diagnosed.

Psycopathy involves a path of risky behavior as well as the potential for being held accountable for it. At any age the behavior that brings they psychopath to the attention of the criminal justice system is often drug or alcohol related. The natural history of the average psychopath reveals an overrepresentation in prison with a 15x greater risk in general. Any statistics on psycopathy in a population is based on psychometric evaluations retrospectively in specific populations. Being arrested or getting caught for something does not reveal the pathology or the correlation. You have to look for it.

And nothing is known of subpopulations of psychopaths and the impact of intelligence, education, profession and other factors and how they relate to outcomes and consequences over time. Egocentricity and a sense of entitlement drives they do not adapt to the environment but try to make the environment adapt to them. Without empathy and lacking remorse the goal is always self-serving and a question of what they can get out of it.

Many judges, as an alternative to incarceration, have been requiring people arrested for drug and alcohol related offenses to attend AA meetings and provide proof of participation. As misguided as this is on other levels it is also dangerous. Given a choice between incarceration and attending AA the majority of any population, including those with psychopathic traits, would choose the latter. And as in any situation they would use it to see what they could get out of it. Masters of manipulation and impression management in a room full of potential victims. The reports of rape and theft coming out is no surprise. It is in all likelihood much worse.

And in reality psychopaths exist in every profession, including medicine.

What is the natural history and final common pathway of M.D. psychopaths? Where do these shape-shifters end up?

In his book Without Conscience, Dr. Robert Hare notes “If we can’t spot them, we are doomed to be their victims, both as individuals and as a society. ” Dr. Clive Boddy in Corporate Psychopaths observes that unethical leaders create unethical followers, which in turn create unethical companies and society suffers as a result.” And if you look at the FSPHP branch of the ASAM that is exactly what you will find. less than 1/% of the population are psychopaths but they represent more that 10% of those in prisons. What is the natural history of the physician psychopath? You do the math.

http://psychopathyinfo.wordpress.com/2012/03/22/characteristics-of-corporate-psychopaths-and-their-corporations/

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Skipper

Psychopathy and the Medical Profession

April 24, 2015April 24, 2015mllangan1 7 Comments

And in reality psychopaths exist in every profession, including medicine.

What is the natural history and final common pathway of M.D. psychopaths? Where do these shape-shifters end up?

In his book Without Conscience, Dr. Robert Hare notes “If we can’t spot them, we are doomed to be their victims, both as individuals and as a society. ” Dr. Clive Boddy in Corporate Psychopaths observes that unethical leaders create unethical followers, which in turn create unethical companies and society suffers as a result.” And if you look at the Federation of State Physician Health Programs (FSPHP) and those in charge of state physician health programs that is exactly what you will find. Less than 1/% of the population are psychopaths but they represent more that 10% of those in prisons. What is the natural history of the physician psychopath? You do the math.

http://psychopathyinfo.wordpress.com/2012/03/22/characteristics-of-corporate-psychopaths-and-their-corporations/

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

April 22, 2015April 22, 2015mllangan1 9 Comments

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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.

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.

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.

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.

Psychopathy and the Medical Profession

January 19, 2015January 19, 2015mllangan1 3 Comments

In his book Without Conscience, Dr. Robert Hare notes “If we can’t spot them, we are doomed to be their victims, both as individuals and as a society. ” Dr. Clive Boddy in Corporate Psychopaths observes that unethical leaders create unethical followers, which in turn create unethical companies and society suffers as a result.” And if you look at the FSPHP branch of the ASAM that is exactly what you will find. It is the perfect funnel for such personalities in our profession–relicensed by claiming the salvation card and an externalization of all blame. “I didn’t do it it was my disease.” In this manner felons, double felons, swindlers and pedophiles have not only gotten their medical licenses back but PUT IN CHARGE of evaluating other doctors in a rigged system with no regulation, transparency or oversight. Bad idea. It is a facade. Less than 1/% of the general population are psychopaths but they represent more that 10% of those in prisons. What is the natural history of the physician psychopath? You do the math.

http://psychopathyinfo.wordpress.com/2012/03/22/characteristics-of-corporate-psychopaths-and-their-corporations/

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Psychopathy Everywhere?

A SPECIAL ME-P REPORT

By Michael Lawrence Langan MD

Psychopathy is present in all professions.

In The Wisdom of Psychopaths: What Saints, Spies, and Serial Killers Can Teach Us About Success, Kevin Dutton provides a side-by-side list of professions with the highest (CEO tops the list) and lowest (care-aid) percentage of psychopaths.

Interestingly surgeons come in at #5 among the professions with the highest percentage of psychopathy while doctors (in general) are listed among the lowest [more ……>]

Psychopathy and the Medical Profession

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Integrity and Accountability—The Declining State of Physician Health and the Urgent Need for Ethical and Evidence-Based Leadership

November 10, 2014November 16, 2014mllangan1 12 Comments

Integrity and Accountability—The Declining State of Physician Health and the Urgent Need for Ethical and Evidence-Based Leadership.

Good leadership requires correct moral and ethical behavior of both the individual and the organization. . Integrity is necessary for establishing relationships of trust. It requires a true heart and an honest soul. People of integrity instinctively do the “right thing” in any and all circumstances. Adherence to ethical codes of the profession is a universal obligation. It excludes all exceptions. Without ethical integrity, falsity will flourish.

The documents below show fraud. It is intentional. All parties involved knew what they were doing, knew it was wrong but did it anyway. The schism between pious rhetoric and reality is wide.

One measure of integrity is truthfulness to words and deeds. These people claim professionalism, ethics and integrity. The documents show a reality of hypocrisy and sanctimony. But the hypocrisy seen here is also a danger because the careers and lives of doctors are in these peoples hands.

Dr. Clive Body in his book Corporate Psychopaths writes that “Unethical leaders create unethical followers, which in turn create unethical companies and society suffers as a result.” And according to Dr. Robert Hare in Without Conscience “If we can’t spot them, we are doomed to be their victims, both as individuals and as a society. ”

Abuse under the utility of medical coloration is especially egregious. It violates the fundamental ethical principles of Medicine -Autonomy, Beneficence, Nonmaleficence and justice. Intentionally falsifying a laboratory or diagnostic test to refer for an evaluation or support a diagnosis or give unwarranted “treatment” is unconscionable.

Similar fraud is occurring across the country.

This is an example of the institutional injustice that is killing physicians. Finding themselves entrapped with no way out, helpless and hopeless they are feeling themselves bereft of any shade of justice and killing themselves. These are nothing more than bullies and accountability is essential.

Physician Health Programs: The Need for Integrity and Accountability of Organizations

November 9, 2014May 29, 2015mllangan1 11 Comments

Accountability, or answerability, is necessary to prevent abuse and corruption. This requires both the provision of information and justification for actions. What was done and why?

Professional guidelines and standards of care, ethical codes of conduct and the law are all objective benchmarks that can be used to assess the actions and decisions of others. In any free society this necessitates the existence of organizations of truly independent opinion capable of standing in this judgment.

State PHPs are Non-Governmental Organizations (NGOs) over which the state health department has no supervisory oversight. There is no regulation, no transparency and no accountability. There is no public scrutiny and they police themselves.

In Ethical and Managerial Considerations Regarding State Physician Health Programs Drs. John Knight and J. Wesley Boyd call for greater oversight and scrutiny of PHPs by the medical community at large. They recommended periodic auditing, national standards and regulation. They also attempted to convince the Massachusetts Medical Society to implement changes at PHS where they served as Associate Directors with over two decades of collective experience.

These efforts to promote transparency and accountability at both local and national levels, however, fell on deaf ears.

State PHPs have systematically removed those not conforming to groupthink. Threatening them with litigation if they breached “peer-review” statutes and confidentiality agreements has effectively silenced them from reporting any misconduct, abuse or even crimes they may have witnessed.

In Massachusetts John Knight was removed in 2009 and J. Wesley Boyd in 2010. In Ethical and Managerial Considerations Regarding State Physician Health Programs they comment “if a PHP highlights a physician as particularly problematic, the evaluation center might–whether consciously or otherwise—tailor its diagnosis and recommendations in a way that will support the PHP’s impression of that physician.” So too will the clinical laboratories.

How is this any different from the case of Dr. Farid Fata, the Michigan oncologist who intentionally diagnosed healthy patients with cancer so he could charge them for unneeded chemotherapy? The U.S. Attorney called it the “most egregious” case of health care fraud ever. His acts may have contributed to one patient death. The institutional injustice of the PHP system is causing countless deaths of physicians.

To consciously “tailor” a diagnosis is fraud. To tailor a diagnosis of substance use disorder or any other psychiatric diagnosis is the political abuse of psychiatry. Misrepresentation, dishonesty, deception, and distortion play no role in the Profession and Guild of Medicine. To do so violates the basic moral principles of Medical Ethics–Autonomy, Beneficence, Non-Maleficence and Justice.

The “PHP-approved” assessment and treatment centers are all staffed by doctors of “like-mind.” It is a rigged game.

An audit of the North Carolina PHP found essentially no oversight from the Medical Board or Medical Society. The audit found that “abuse could occur without being detected,” and this is by design. By removing and blocking the provision of information necessary for accountability, restricting the liberties and freedoms of physicians, and increasing their power and control they have erected a framework of hidden abuse.

The situation in North Carolina is standard operating procedure for PHPs under the Federation of State Physician Health Programs (FSPHP). It is not the exception but the rule.

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

To whom are the PHPs accountable? Whom do they represent? There are legitimate concerns.

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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)

The Medical Follies

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A SPECIAL ME-P REPORT

By Michael Lawrence Langan MD

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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)