How False Constructs Come to Be Regarded As Irrefutable Truth: The “Disruptive Physician”, Addiction Medicine Specialists and the 21st Century Inquisition of Doctors–Let’s See if She Floats!

Screen Shot 2014-02-24 at 9.19.46 AM“This physician may be clinically competent; indeed, he may be technically superior. However, no one wants to refer patients to him. No one wants to assist him in surgery. He is the one who screams at nurses, belittles medical students and makes criticisms that go beyond the bounds of fair professional comment. However, he is not always loud. He can be the passive physician who will not answer the pager while on call, who does not show up at meetings and will not help find solutions to departmental problems. Indeed, this physician is not always male, but more often than not that seems to be the case.”

So begins “The Dreaded Task of Confronting Disruptive Physicians,” 1 a call to arms by Dr. Graeme M. Cunningham, M.D. (Fellow of the American Society of Addiction Medicine) published in the Journal of Medical Licensure and Discipline in 2004  (The official publication of the  Federation of State Medical Boards (FSMB)) that helped launch a new paradigm for all those concerned with the physician “who has long eluded regulatory action, even though his behavior may have posed a risk to patient care and created chaos in his workplace for a number of years.”1

These experiences lead us to the tentative conclusion that disruptive behavior, if not dealt with properly, is often the symptom of a greater underlying problem that will impede the safe practice of medicine. What may seem to be largely an annoyance could be a symptom, endangering patients. If identified early, disruptive physicians can be effectively treated and should be referred to appropriate programs for treatment.2

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The American Society of Addiction Medicine and Federation of State Physician Health Programs (PHPs) set forth definitions of disruptive behavior, rules of evidence and regulation and the administrative procedures by which suspected doctors were “evaluated” and removed from practice.3

Written by the PHP doctors for PHP doctors, the disruptive physician construct came to be regarded as irrefutable truth and contributed to the identification and removal of an undetermined number of medical doctors. Although there was a general belief in “disruptive physicians” at the time of this call to arms they were not regarded as evil or life threatening. Society did not fear them and hospital administration and regulatory medicine did not feel the need to hunt them down. There were many scholars who publicly doubted this epidemic of disruptive physicians at the time. That would soon change.

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On July 9, 2008 the Joint Commission became so concerned about “behaviors that undermine a culture of safety” that it issued a “Sentinel Event Alert” on the topic and developed a “Leadership Standard” requiring all hospitals to have a code of conduct as well as a process for managing disruptive and inappropriate behaviors.4-6

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In 2011 the Federation of State Medical Boards issued an updated “Policy on Physician Impairment” giving full authority to physician health programs in the evaluation, treatment and ultimate fate of these doctors. The  FSMB House of Delegates adopted an updated Policy on Physician Impairment at their annual meeting distinguishing “impairment” and “illness”  stating that

“Regulatory Agencies should recognize the PHP as their expert in all matters relating to licensed professionals with “potentially impairing illness.”

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According to the FSPHP, physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years.” The policy extends PHP authority to cover physical illnesses affecting cognitive, motor, or perceptive skills, disruptive physician behavior, and “process addiction” (compulsive gambling, compulsive spending, video gaming, and “workaholism”). It also defines “relapse without use” as “behavior without chemical use that is suggestive of impending relapse.”

From the mid 1980s until present day a confederacy of “authorities” calling themselves “addiction medicine” specialists assisted in identifying disruptive physicians. Shaping clinical and legal orthodoxy they set the standards that cooperating regulatory authorities could follow in criminalizing, persecuting and punishing heretics.imgres

Behavioral manifestations included not answering pages on time, untimely or illegible chart notes, being late for meetings and questioning hospital authority.   Disruptive physicians were blamed for everything—patient morbidity and mortality, increasing malpractice costs and decreased hospital revenue.

Using the nebulous “disruptive physician” label, anyone with a grudge or suspicious could accuse anyone of misbehavior, malice and mayhem.

Propaganda, threats, misinformation, guild assumed from the start, PHP oversight of disruptive physician persecution was standard.

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During the state PHP “disruptive physician” with-hunts the legal notion of crimen exceptum (an exceptional and most dangerous crime) allowed for the suspension of normal rules of evidence to punish the guilty.

Because of the nature of the enemy the evidentiary bar was lowered and any witness, no matter what his credentials, could report a doctor to the state PHP.

Belief in the seriousness of the situation rationalized cruelty.

Professional experts used lie-detector tests (polygraphs), non-validated neuropsychological instruments, and non-FDA approved drug and alcohol tests to confirm the accusations.   The accused often did not pass these tests due to “tailoring” the results to fit the PHPs wishes and often received positive biomarker tests due to the ubiquity of the chemicals tested for. Bananas, sauerkraut, bakers yeast, urinary tract infections and hand sanitizer were often the cause. False accusations, if exposed, were excused if they were a result of “zeal for the faith.”

The consequences of being branded a heretic by questioning the existence “disruptive physicians” essentially silenced any dissenting voices and the notion of crimen exceptum freed the consciences of those involved.

Sanctimony, feigned piety and hypocritical devoutness was used as justification.  After all–Torture and torment are a small price to pay when it comes to protecting the public and saving souls.

Through the “disruptive physician” trials clerics, “addiction medicine” specialists, psychologists, neuropsychologists, commercial drug-testing labs, assessment and rehabilitation facilities and lawyers used their expertise as witnesses to increase their prestige.   The “disruptive physician” developed into a means of economic profit.  Some gained a lot of money from the “disruptive physician”.  The accused doctor and his or her relatives paid out of pocket for those who worked the “disruptive physician” trials including those doing the testing, assessment and treatment.

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“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.” So too is hunting the “impaired,” “disruptive” and “aging” physician and the costs are usually paid by the accused.

Their property was lost to pay the revolving door of testing, assessment and treatment and those overseeing it raked in increasingly large sums of money as well as other reliable assets. A doctor accused could easily be ruined permanently.

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 in 2015 nothing has changed.

Context, characters and circumstances may differ but the mechanics do not.

The mosaic remains the same.  

False constructs come to be regarded as irrefutable and the creation and chains of causation remain timeless

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  1. Cunningham GM. Editorial: The Dreaded Task of Confronting Disruptive Physicians. Journal of Medical Licensure and Discipline. 2004;90(2):6-7.
  2. Summer GL, Ford CV, Lightfood WM. The Disruptive Physician, I: The Alabama Physicians Recovery Network. Federation Bulletin. 1997;84(4):236-243.
  3. Bohigian GM, Bondurant R, Croughan J. The impaired and disruptive physician: the Missouri Physicians’ Health Program–an update (1995-2002). Journal of addictive diseases. 2005;24(1):13-23.
  4. Grenny J. Crucial conversations: the most potent force for eliminating disruptive behavior. Physician executive. Nov-Dec 2009;35(6):30-33.
  5. Huff DJ, Cline LE. Another reason to be on your best behavior: the Joint Commission’s new disruptive physician standard. Journal of the Medical Association of Georgia. 2009;98(2):17-18.
  6. Leiker M. Sentinel events, disruptive behavior, and medical staff codes of conduct. WMJ : official publication of the State Medical Society of Wisconsin. Sep 2009;108(6):333-334.Max-1


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“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.

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Although there was a general belief in witches at the time theas published they were not regarded as evil or life threatening.  Society did not fear them and Church and Political authority  certainly did not feel the need to hunt them down.   There were many scholars who publicly doubted the existence of witches at the time.  That would soon change.

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After being snubbed by secular and ecclesiastical authorities in his witch-hunting pursuits, the  Dominican friar and German Inquisitor Heinrich Kramer told Pope Innocent VIII of a  dangerous outbreak of witches that had occurred in the region.    This diabolical conspiracy hell-bent on destroying humanity needed to be identified and destroyed for the public good, but church authorities were not cooperating.

On December 5th, 1484 Pope Innocent VIII issued the papal bull Summis Desiderantes affectibus giving full authority to proceed with “correcting, imprisoning, punishing, and chastising” such persons “according to their deserts,”  and threatening to sanction or excommunicate those who hindered the pursuit.

images-18From the late 15th century through the early 17th century a confederacy of “authorities” calling themselves demonologists assisted in identifying witches. Shaping ecclesiastical orthodoxy they set the standards that cooperating political authorities could follow in criminalizing, persecuting and punishing heretics.

Behavioral manifestations  included living alone, cultivating strange herb and saying hello to a neighbors cat.Witches were blamed for everything—plague, crop failure, and erectile dysfunction.

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

Propaganda, threats, misinformation, guilt assumed from the start.

male31Physician oversight of witch persecution was standard.

During the European witch-hunts the  legal notion of crimen exceptum (an exceptional and most dangerous crime] allowed for the suspension of normal rules of evidence to punish the guilty.

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

Belief in the seriousness of the situation rationalized cruelty.

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The Devil’s mark (Stigmata diaboli) was taken as the mark of a witch entailing close inspection.

Professional witch-prickers used  needles, pins and bodkins to poke the skin with lack of bleeding confirming the accusation.   The accused did not bleed due to retractable needles and sleight of hand.   False accusations, if exposed, were excused if they were a result of “zeal for the faith.”

The consequences of being branded a heretic  by questioning the existence of witches essentially silenced any dissenting voices and the notion of crimen exceptum freed the consciences of those involved.

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Sanctimony, feigned piety and  hypocritical devoutness was used as justification.  After all–Torture and torment are a small price to pay when it comes to protecting the public and saving souls.

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.

matthew“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.

Far from the conventional image of a penniless hag, a significant proportion of accused witches, especially in Germany, were wealthy and male.

Their property was seized to pay the clergymen, judges, physicians, torturers, guards, scribes, and laborers who raked in increasingly large sums of money as well as other reliable assets.

With a single member accused, a moderately wealthy family could be ruined permanently.

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.

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 Context, characters and circumstances may differ but the mechanics do not.

The mosaic remains the same.  

The Malleus shows how false constructs come to be regarded as irrefutable and the creation and chains of causation are timeless.

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Bent Science and Bad Medicine: The Medical Profession, Moral Entrepreneurship and Social Control

Disrupted Physician

IMG_9005The Medical Profession, Moral Entrepreneurship, and Social Control

Sociologist Stanley Cohen  used the term “”moral panic” to characterize the amplification of deviance by the media, the public, and agents of social control.1  Labeled as being outside the central core values of consensual society, the deviants in the designated group are perceived as posing a threat to both the values of society and society itself.   Belief in the seriousness of the situation justifies intolerance and unfair treatment of the accused.   The evidentiary standard is lowered.

Howard Becker describes the role of “moral entrepreneurs,” who crusade for making and enforcing rules that benefit their own interests by bringing them to the attention of the public and those in positions of power and authority under the guise of righting a society evil. 2

And according to cultural theorist Stuart Hall, the media obtain their information from the primary definers of social…

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Rantings from the Bully Pulpit

 

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The three e-mails below were received within a twenty-four hour period from a physician supporting (and in all likelihood involved in) drug courts and physician health programs (PHPs).  E-mails such as this are invariably anonymous and I usually drag them right to the trash where they belong  but the trio below provides valuable insight into the mentality of those involved.  And for that reason I am posting them as they were received.

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

He presents either/or logical fallacy and  false dichotomy.  You are either with us or against us!  He appeals to professionalism yet his words show he has no  inkling of the true definition, resorts to simple-minded cliches and meaningless platitudes and then sinks into ad hominem attacks on my blog and then me.

Ironically he accuses me me of ranting in a rant!

He is a prototypical example of the sham-artist physicians typically involved in these programs–an authoritarian paternalistic know-it-all who can only rant under the shield of gang-stalking power or a shroud of absolute anonymity.

As I have said time-and-time again if any factual errors exist in my blog I will not only remove them but remove my blog.

So I am going to make this offer to “TT Wilson”–if you wish to provide a rebuttal of any of the documentary evidence I provide in my blog herein then do so now.  If you can I will delete the whole kit and kaboodle.  Simple as that.

You Sir are an incompetent and a coward.  If not then prove me wrong. I challenge you to reveal your true identity. Let’s level the playing field a tad on this.  It is easy to present an opinion while cowardly hiding behind a veil of anonymity.  Let’s see if you have the courage to debate this publicly.

I won’t be holding my breath on this one.


 

February 7, 2015 7:45 PM

Comment:  It looks like it is too late already.  The ABAM is closer than ever to becoming a member of the ABMS, there is a big push from the Obama administration to fund addiction treatment and to greatly widen access.  As communities see how well run addiction programs save lives and force crime away from their homes the trend will be very hard to stop.  I agree, PHPs are draconian when they work with physicians thought to have SUDs, but I would rather have them too tough than too lax.  And a sober physician should be OK with that.

February 7, 2015  3:00 PM

Comment: Actually well run drug courts help patients who would have otherwise kept using substances of abuse.  Drug courts are quite dictatorial by design and clearly a defiant patient will defeat even the most caring and competent efforts to help them.  Of course we prefer that the patients be in a stage of change that leaves them open to treatment, but more than a few we’ve helped were not about to change without pressure from the court.

And I stipulated well run drug courts.  There are many incredibly poorly run drug courts.  When a judge doesn’t get it things are just as bad or worse than when the medical team doesn’t get it.  And the studies done are typically dismal.  Very short, small sample size, no standardization.  

As far as impaired physicians are concerned, it is not enough to just stop using and declare innocence.  If a cardinal event has attracted the attention of the medial (sic) board and that board requires participation in treatment to maintain licensure, well that goes with the license.  You can certainly choose not to participate, and the board can then choose to not let you practice.  They do the same thing with physicians with psychiatric issues.  And they encounter a huge amount of denial in this population, I would say more so than the lay population.  At least the denial is louder.

Dictatorial — sure.  Fair — well, no.  But life is not fair.  

As doctors we owe it to our patients to be held to a higher standard.  If someone of authority says I need to be screened, they are most welcome to any fluid or hair sample they require.  Is that fair?  Surely not.  Does that make it bad?  Not at all.

Do you have a better approach?  So far you haven’t demonstrated it in your myriad postings.

As far as ABAM is concerned, have you cried out about the ER boards, Pain Medicine boards, and all of the other boards that have been added to the charter members of the ABMS over the years?  Heck, back in the day a buddy of mine was grandfathered into the board of Plastic Surgery without even taking a test.  He sent them $500 and he was board certified.  Got a really nice certificate too, but it didn’t come with a frame.  Years later they started requiring fellowship training and actually taking a test.

I enjoy your site — clearly there are problems with the way care is being delivered by some individuals in some cases.  Of course that is true of every aspect of medicine.  No one is advocating that we shut down every other aspect of medicine.  Well some are, but that is for another discussion.  

My concern is that your ranting will deter some people away from meaningful treatment, very much like those who seethe against vaccinations lead the unknowing to not treat their children.  If I was cynical I could invoke Darwin here.  Thinning the herd.  

And you might want to get some help with wordpress.  This endless scrolling is distracting.  I was missing a good third of your content.

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February 7. 2015  9:45 PM

Comment: Finally made it to your last entry.  Please learn how to conduct a wordpress blog — your technique is very distracting.

You protesteth too much good sir.  Put aside your denial and get some treatment.  I am sure Harvard was glad to be rid of you.  They are very lucky you are out of there.

There might be some legitimate content in there somewhere, but by the time I reached the bottom of the page I was ready to hand you a mood disorder questionaire.  Not that we really need you to fill one out to make a diagnosis.

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johnnyLawrence

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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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Free Educational Webinar: How to Position Yourself as an EXPERT!

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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.

I have asthma but that does not make me a Pulmonologist.  That addiction “specialist” diagnosing and treating you may have 5 years prior been a proctologist; and maybe not even a very good one at that.

Somewhere there may be doctor with no post-graduate training in surgery wielding a scalpel and calling himself an expert surgeon, but it is difficult to imagine that he is a very good one.

http://disruptedphysician.com/2014/11/18/disrupted-physician-101-2-for-what-its-worth-appeal-to-authority-and-the-logical-fallacy-of-special-or-secret-knowledge/

 

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Addiction Medicine: The Birth of a New Discipline

Somehow, I don't think this is quite what they had in mind!

Ms (Leigh) Bella St John


“How to Position Yourself as an EXPERT, Make More Money and Help More People, by Becoming a Published Author – Even if You Don’t Know Where to Start!” Think about it – if you need to see a chiropractor, for example, would you rather see a general chiropractor, or one who has positioned …
http://leighstjohn.com/free-educational-webinar-how-to-position-yourself-as-an-expert/

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Disrupted Physician 101.3 –“For What it’s Worth”— The ASAM/ABAM Diploma Mill

“In a time of universal deceit, telling the truth is a revolutionary act.”
— George Orwell

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I can think of no other specialty or subspecialty in the profession of medicine where non-existent expertise can be incontestably announced and implemented.  If I claimed to be an ace neurosurgeon or an expert otolaryngologist and started practicing my claimed skills in the hospital I would be called on it pretty quick by both colleagues and patients–deemed a delusional fraud and run out on a rail within a week.  Both law enforcement, attorneys and psychiatry would be called in short order.

Yet doctors who have not met the usual and customary standards for professional and educational quality that have been identified for medical specialties and subspecialties are able to claim expertise in “addiction medicine” and everybody just lets them.

To make this point I sat for the 2010 American Board of Addiction Medicine Certification Examination.  I did this to make a point–kind of like seeing how easy it is to buy a gun at a Walmart.

I simply went to the ABAM Website, completed the application and paid the fee.

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The requirements to sit for the exam included so many “practice experience hours” over the past five years and 50 CME credits related to addiction.

With a year of psychopharmacology research, a half-day per week moonlighting at the MBTA medical clinic giving drug tests to bus drivers and another overnight moonlighting job giving medical clearance to patients at a local psychiatric hospital detox unit I satisfied the first requirement.   For the latter I looked through the last five years of morning reports, noontime lectures and grand rounds I went to and added them up and, falling a little short supplemented the CME credits with some online modules.

And with that I was given a date at Pearson to take the test.

I have absolutely no training or education in the field of addiction medicine.  I didn’t pick up a book or study anything. I did not prepare at all. I did not even get a good night’s sleep the night before and stayed up until 2:30 a.m.   Nevertheless I went to the testing facility the next morning and finished the test within an hour and a half.  My score is below.  Aced it.   Passing score was 394 and I got a 459.

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And the point I am trying to make is I am no expert in Addiction Medicine.  Neither is 4000 of me. Yet the letter below says I am.  Majority apparently rules.

Giving false expertise to the unqualified and granting them power over others is just as dangerous as the gun from Walmart.  They can both kill.

An interest in something does not an expert make. If we allow this then the ASAM 12-step chronic brain disease model not only swallows addiction medicine but tarnishes all of medicine.  An imposition by force and the deep pockets of the billion dollar drug and alcohol testing, assessment and treatment industry.

ASAM is not a true medical specialty. It is a special interest group.   ABAM is not recognized by the American Board of Medical Specialties (ABMS).

The arguments seem to be:

1) Addiction is a prevalent “disease”  that needs to be “treated;”

2) There are not enough Addiction Psychiatrists to diagnose and treat them.

3) Being an M.D. addict or alcoholic gives enough knowledge and apprenticeship skills to diagnose and treat others with the same affliction.

4) Let’s utilize them to fill the void.

This is logical fallacy and it is dangerous.

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 interest in something does not an expert make.  I had an interest in science as a child but my certification as a member of Sir Isaac Newton’s Scientific Club did not make me a scientist.

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I have asthma but that does not make me a Pulmonologist.  That addiction “specialist” diagnosing and treating you may have 5 years prior been a proctologist; and maybe not even a very good one at that.

Somewhere there may be doctor with no post-graduate training in surgery wielding a scalpel and calling himself an expert surgeon, but it is difficult to imagine that he is a very good one.

I received my ABMS certification without meeting a single person. It was all done by mail.   This fits the very definition of “Diploma Mill.”  This is not to besmirch those with a sincere interest in helping others with addiction.  Many if not most of those involved are sincere. But this is not expertise.  This is not authority. And, as we have seen, this low bar opens the door for some very bad apples.

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“This election is not about issues,” Rick Davis, John McCain’s campaign manager said this week. “This election is about a composite view of what people take away from these candidates.” That’s a scary thought. For the takeaway is so often base, a reflection more of people’s fears and insecurities than of our hopes and dreams.
— Judith Warner, New York Times, September 4, 2008

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

“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).
 
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In order to comprehend the current plight of the Medical Profession and the dark clouds that lie ahead it is necessary to understand the history of the “impaired physician movement” and the American Society of Addiction Medicine.

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.”1

The impaired physician movement emphasizes disease and therapy rather than discipline and punishment and believes that addiction is a chronic relapsing brain disease requiring lifelong abstinence and 12-step spiritual recovery. The drug or alcohol abuser or addict is a person lacking adequate internal controls over his or her  behavior;  for his own protection as well as the protection of society external restraints are required including involuntary treatment.

The American Society of Addiction Medicine can trace its roots to the 1954 founding of the New York City Medical Society on Alcoholism (NYCMSA) by Ruth Fox, M.D whose husband died from alcoholism.

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Finding that alcoholics in her psychoanalytic practice did not recover when she used conventional analytic approaches, she taught her patients about alcoholism as a disease and introduced “them to AA meetings held in her living room.”2

A number of physicians in the New York Medical Society were themselves recovering alcoholics who turned to Alcoholics Anonymous for care.3

The society, numbering about 100 members, established itself as a national organization in 1967, the American Medical Society on Alcoholism (AMSA).3

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The group promoted the concept of alcoholism as a chronic relapsing disease requiring lifelong spiritual recovery through the 12-steps of AA.

By 1970 membership was nearly 500.2Screen Shot 2014-02-22 at 2.47.51 PM

In 1973 AMSA became a component of the National Council on Alcoholism (NCA), now the National Council on Alcoholism and Drug Dependence (NCADD) in a medical advisory capacity until 1983.

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“Abstinence from alcohol is necessary for recovery from the disease of alcoholism” became the first AMSA Position Statement in 1974.2

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In 1985 ASAM’s first certification exam was announced. According to Dr. Bean-Bayog, chair of the Credentialing Committee:

“A lot of people in the alcoholism field have long wanted physicians in the field to have a high level of skills and scientific credibility and for this body of knowledge to be accredited.”2

And in 1986 662 physicians took the first ASAM Certification Exam.medical

By 1988 membership was over 2,800 with 1,275 of these physicians “certified” as:

“having demonstrated knowledge and expertise in alcoholism and other drug dependencies commensurate with the standards set forth by the society.”4
“While certification does not certify clinical skill or competence,” the Board explained, “it does identify physicians who have demonstrated knowledge in diagnosis and treatment of alcoholism and other drug dependencies.”5
Somehow, I don't think this is quite what they had in mind!

Somehow, I don’t think this is quite what they had in mind!

Achieving “recognized board status for chemical dependence” and fellowships in  “chemical dependency”  are among the five-year objectives identified by the group.  These are to come to fruition by  “careful discussion, deliberation, and consultation” to “determine its form and structure and how best to bring it about.”5

The formation of ASAM State Chapters begins with California, Florida, Georgia, and Maryland submitting requests.6

In 1988 the AMA House of Delegates votes to admit ASAM to the House. According to ASAM News this “legitimizes the society within the halls of organized medicine.”2

In 1989 the organization changes its name to the American Society of Addiction Medicine (ASAM).2

Since 1990, physicians have been able to list addiction medicine as a self-designated area of practice using the specialty code “ADM.”

By 1993 ASAM has a membership of 3,500 with a total of 2,619 certifications in Addiction Medicine.

The Membership Campaign Task Force sets  a goal to double its membership of 3,500 to 7,000 by the year 2000 to assure “the future of treatment for patients with chemicals. It represents a blueprint for establishing addiction medicine as a viable entity.”7

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Ninety physicians become Fellows of the American Society of Addiction Medicine (FASAM) in 1996 “to recognize substantial and lasting contributions to the Society and the field of addiction medicine.”8

Among the honorees are Robert DuPont, G. Douglas Talbott, Paul Earley, and Mel Pohl. In addition to at least five consecutive years of membership and certification by the Society, Fellows must have “taken a leadership role in ASAM through committee service, or have been an officer of a state chapter, and they must have made and continue to make significant contributions to the addictions field.”8

The American Board of Addiction Medicine (ABAM) is formed in 2007 as a non-profit 501(C)(6) organization “following conferences of committees appointed by the American Society of Addiction Medicine” to “examine and certify Diplomats.”9

In 2009 National Institute on Drug Abuse (NIDA) Director Nora Volkow, M.D., gives the keynote address at the first ABAM Screen Shot 2014-11-18 at 10.12.23 AMboard certification diploma ceremony.10

According to an article in Addiction Professional “Board certification is the highest level of practice recognition given to physicians.”

“A Physician membership society such as ASAM, however, cannot confer ‘Board Certification,’ ” but a“ “Medical Board such as ABAM has a separate and distinct purpose and mission: to promote and improve the quality of medical care through establishing and maintaining standards and procedures for credentialing and re-credentialing medical specialties.”

The majority of ASAM physicians meet these requirements by “working in a chemical dependency treatment facility, taking continuing medical education courses in addiction, or participating in research.”11

“In the United States accredited residency programs in addiction exist only for psychiatrists specializing in addiction psychiatry; nonpsychiatrists seeking training in addiction medicine can train in nonaccredited ‘fellowships,’ or can receive training in some ADP programs, only to not be granted a certificate of completion of accredited training.”11

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Specialty recognition by the American Board of Medical Specialties, fifty Addiction Medicine Fellowship training programs and a National Center for Physician Training in Addiction Medicine are listed as future initiatives of the ABAM Foundation in 2014.

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’12   

In this they have succeeded.

And in the year 2014 G.V. 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.Screen Shot 2014-11-18 at 10.11.55 AM

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.

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  1. Stimson GV. Recent developments in professional control: the impaired physician movement in the USA. Sociology of health & illness. Jul 1985;7(2):141-166.
  2. Four Decades of ASAM. ASAM News. March-April 1994, 1994.
  3. Freed CR. Addiction medicine and addiction psychiatry in America: Commonalities in the medical treatment of addiction. Contemporary Drug Problems. 2010;37(1):139-163.
  4. . American Medical Society on Alcoholism & Other Drug Dependencies Newsletter. Vol III. New York, NY: AMSAODD; 1988:12.
  5. Ursery S. $1.3M verdict coaxes a deal for doctor’s coerced rehab. Fulton County Daily Report. May 12, 1999b 1999.
  6. . AMSAODD News. Vol III. New York, NY: American Medical Society on Alcoholism & Other Drug Dependencies; 1988.
  7. Membership Campaign Update. ASAM News. Vol VIII: American Society of Addiction Medicine; 1993:11.
  8. . ASAM News. Vol 12. Chevy Chase, MD: American Society of Addiction Medicine; 1997:20.
  9. http://www.abam.net/about/history/.
  10. Kunz KB, Gentiello LM. Landmark Recognition for Addiction Medicine: Physician certification by the American Board of Addiction Medicine will Benefit all Addiction Professionals. Addiction Professional. 2009. http://www.addictionpro.com/article/landmark-recognition-addiction-medicine.
  11. Tontchev GV, Housel TR, Callahan JF, Kunz KB, Miller MM, Blondell RD. Specialized training on addictions for physicians in the United States. Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse. Apr 2011;32(2):84-92.
  12. http://www.asam.org/about-us/mission-and-goals.

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