I wrote this essay in response to Michael Langan’s piece (reblogged on this site) on the crucial importance of diagnostic accuracy (6/5/2015)
Very pleased to see Michael’s explanation of diagnostic accuracy, especially in his coverage of the dangers of false positives.
While he covered it elsewhere in his blog, it bears highlighting that while a “false positive” in clinical medicine can lead to more refined testing before one begins on a costly treatment regimen, a “false positive” in forensic medicine can lead not only to loss of one’s right to practice but in fact to one’s very freedom. And, since the very test that is yielding the false positive is explicitly known to produce such, the likelihood that more people are going to be falsely deprived of their civil rights and their fundamental liberty is concomitantly higher. PHPs and Medical Boards know this and have been complicit with this scam.
This would be bad enough even if considered alone. But in the white collar licensed professions like medicine, the use of such a test occurs in a setting where the deprivation of the protections afforded by due process is routine. In other words, if the test comes back positive – even though it’s a false positive – you’re guilty until proven innocent. And you’ve got to spend a fortune to prove your innocence while you’re removed from your practice, deprived of making a living, and coerced into a “preferred program” for extended treatment and 5 years of “monitoring” – ironically using the very same test that falsely established your diagnosis! And it will take years to extract yourself from such a bureaucratic entanglement. One thing is certain – you will not come out of this mauling intact. You will be like the increasing numbers of unfortunates who have been set up by a deeply broken judicial system, framed on false evidence, and sent to prison.
Astoundingly, some Physician Health Programs (PHPs and PHSs and congeners) are using an alcohol usage screening test (the EtG amongst others) that they got approved as a LDT – a laboratory developed test (see elsewhere on his blog). That LDT bypassed the FDA process which requires rigorous testing to establish its sensitivity and specificity, in other words to prevent a test from being introduced into the market which yields too many false positives.
But here’s the more amazing thing – SAMHSA, the Substance Abuse and Mental Health Services Administration (a division, I believe, of DHHS), actually issued two explicit alerts in both 2006 and 2012 specifically advising against these tests’ usage in the forensic environment. The PHP enterprise is explicitly a forensic enterprise as, by definition of their role, they are conducting “fitness-for-duty” forensic diagnostic psychiatric evaluations on behalf of a professional (here, the medical) licensing board.
The conclusions are obvious. PHPs are knowingly using tests which produce false positives to incriminate physicians and compel them to enter into their “preferred network” of costly evaluation and lengthy 3 month treatment programs. Ad they are under state protection in doing so. And the medical licensing boards with which they are affiliated are fully complicit in this crime.
I am convinced this will turn out to be a scandal equivalent in magnitude to the Annie Dookhan falsified evidence case and the forensic fraud committed by the FBI’s hair and fiber analysis forensic lab (uncovered by FBI whistleblower Fred Whitehurst) and the compounding pharmacy contamination scandal.
Do you realize how many physicians (and many other medical professionals’) careers have been sabotaged by this fraud? Do you realize how many other professionals are soon going to be subjected to similar “professionals health / employee assistance” programs testing abuses? And then marched into their licensing boards for a kangaroo court? If physicians and other professionals don’t wake up and demand accountability, especially given the worsening prognosis for being provided due process in responding to such contrived findings, it’s going to be too late. Their careers, as unbelievable as it may seem, will be wiped out.
In a separate essay, I’ll write about the perverse incentives that keep such a system embedded. For now: it feeds the legal “professional license defense” industry; it makes it look like the medical licensing board and their legal department and investigators are “protecting the public;” it let’s PHPs keep their lucrative referral pipeline of falsely diagnosed docs flowing to their “preferred programs,” all of which are FSPHP members; and it creates an exceedingly fine profit potential for the drug testing labs, a select number of which the member PHPs also have “preferred relationships” with. (Some treatment programs actually own their own labs!).