The Regulatory Capture of American Medicine by the Drug and Alcohol Testing, Assessment and Treatment Industry  by Michael Langan, MD

The Regulatory Capture of American Medicine by the Drug and Alcohol Testing, Assessment and Treatment Industry

Another incisive piece by Dr. Langan on the crucially important concept of “regulatory capture” of a market sector, in this case the Physicians Health Program.  Clearly, Medical Licensing Boards (MLBs) have mastered the art of regulatory capture, essentially writing legislation which includes stipulations that essentially allow them to write their own rules as they see fit. Then, covered by that state’s sovereign immunity, they’re essentially tin-pot dictators. Then, allied with PHPs who are extended the same sovereign immunity with utterly no oversight or accountability and, which in multiple states, are alleged to have neglected (and thwarted) all means of due process, one has a co-conspirator in the regulatory capture. Now two “state agencies” (in quotes because the recent SCOTUS FTC v. NC Dental decision throws their claim of “state agency” into major question) operate in tandem to both capture the regulatory process by which physicians operate and then collude with other states’ MLBs and PHPs to ensure pan-country (and essentially worldwide) total regulatory control over the professional licenses of physicians.

Clearly, this is not what state legislatures had in mind. And clearly,  federal courts have no idea about the concept of “regulatory capture” of what should otherwise be a low-level administrative function. However, MLBs and PHPs have leveraged their power in this arena to such dictatorial levels that they have essentially overthrown from within all means and understandings of justice which a professional licensee is constitutionally entitled to.

There is much to be alarmed about here. While it may have started out as benign and well-intentioned, the slippery slope is extreme, and in the context of utterly no oversight or accountability, the consequences are dire.

Disagree with an approach to treating Lyme disease? Adjust the criteria defining Lyme disease and then find the doc guilty of practicing outside of the regs. (see Jemsek case in NC / 4th Circuit). Disagree with a pesky internal whistleblower who’s calling attention to billing irregularities, get a crony to file an anonymous complaint. Don’t like someone’s stance on pro-choice or including gun violence in the clinical dialog, report anonymously to the MLB. Or, if you’re a board member or staff, simply get the process rolling of your own accord via secret meetings.

Yes, it’s gotten that dangerous.

 

 

The Federation of State Physician Health Programs and the Dead Doctors at Ridgeview-A Harbinger of the Medical Profession’s Current Suicide Epidemic

Deeply distressing story of Talbott’s Ridgeview Rehab program in which a string of suicides was alleged to have been related to the care provided there. And the same abusive model seems to have been replicated in “rehab” programs across the country.

Disrupted Physician

“There is enormous inertia—a tyranny of the status quo—in private and especially governmental arrangements. Only a crisis—actual or perceived—produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around. That, I believe, is our basic function: to develop alternatives to existing policies, to keep them alive and available until the politically impossible becomes politically inevitable.” –Milton Friedman

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“Gentlemen, it is a disagreeable custom to which one is too easily led by the harshness of the discussions, to assume evil intentions. It is necessary to be gracious as to intentions; one should believe them good, and apparently they are; but we do not have to be gracious at all to inconsistent logic or to absurd reasoning. Bad logicians have committed more involuntary crimes than bad men have done intentionally.”–Pierre S. du Pont (September 25, 1790)

 “It is easier to believe a lie one…

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MD Sues NC Medical Board/Physician Health Program-A Prototypical Case

A most relevant blog piece.

Disrupted Physician

A prototypical case involving PHP and Medical Board. PHPs’ integrity varies state by state depending on:

1. How entrenched the FSPHP is in the state PHP

2. Whether that state’s Medical Board has become a partner in PHP’s crimes.

It is very curious that states who have had a Medical Director who has also been President of the Federation of State Physician Health Programs seem to be the worst of the violators.

Based on over 200 responses I have received on my PHP survey [PHP Survey], North Carolina, Florida, Massachusetts and Washington State are physician career destroyers whereas West Virginia seems relatively unscathed (although I have learned that the FSPHP has been attempting to impose its “PHP-Bluprint” on the Board with some resistance.

What you see here is a classic case. Physicians and med schools urgently need to become aware and take a stance of resistance to…

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Request Medical School Administrators Question PHP Authority to Prevent Future Medical Profession Brain Drain

Another incisive piece by Michael Langan MD on the overreach of PHPs into med schools, essentially hijacking med students’ careers before they’ve even gotten their MD and fleecing them with sham diagnostic evals and out-of-state referrals to their “preferred” centers.

Disrupted Physician

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Physician Health Programs (PHPs) now targeting medical students–More sheep for the slaughter

The attached article entitled “Medical school drug testing is a moral and scientific failure” opposes testing medical students for drugs and alcohol but things are going to get a whole lot worse.

In the past six-months I have been contacted by an increasing number of  medical students searching for help after being  trapped in quagmire of their state physician health program  (PHP).   Each of them had either been referred to a “PHP-approved” assessment center or had already had an evaluation recommending inpatient treatment.

Some of these students were subjected to non-FDA approved laboratory developed tests including hair testing for marijuana metabolites and the  alcohol  biomarker EtG.  These typeof tests can detect substances that were used days, weeks and even months prior to testing.

Medical students and physicians are just as likely to have experimented with illicit substances in their lifetimes as…

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400 Doctors are Killing Themselves Every Year: The Role of Licensure Complaints in Doctor Suicide

Here’s an incredibly incisive piece about medical licensing board complaints and the adverse psychological sequelae.

medfly.org

Matt Freeman DNP, MPH

“Doug” looked happy to be in a white coat. He was energetic, intrigued, and looked genuinely happy to be working with me. Doug was medical student, assigned to me just for a few evenings at a free clinic. Like me, he spoke Spanish, and liked the opportunity to put his language skills to work.

Doug was ahead of the game. He was quick to formulate a provisional diagnosis and plan. One patient had come in for a follow up on her high blood pressure. I would often ask questions like “so what crosses your mind in a hypertension follow-up visit?” Most students would volunteer thoughtful suggestions like, “Make certain that she hasn’t run out of pills.” Doug was thinking ahead: “See if she has signs of heart failure.” That was worth an “A+” in my experience teaching first- and second-year students.

Doug went on to residency…

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The Looming Fraud Case Against PHPs and Medical Boards

lab fraud $$

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.

Stop Fraudulent Lab Testing!

Stop Fraudulent Lab Testing!

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!).

Diagnostic Testing 101.1: The Importance of Sensitivity, Specificity and Diagnostic Test Accuracy

Michael has written a fine piece on the role of accuracy of diagnostic testing and the implications of using tests known to produce false positives in the PHP / Medical Board environment.

Disrupted Physician

To have striven, to have made an effort, to have been true to certain ideals — this alone is worth the struggle. We are here to add what we can to, not to get what we can from, life. – William Osler


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Diagnostic Medicine

Diagnostic medicine is the process of identifying the condition or disease that a patient has and  ruling out conditions or diseases the patient does not have through assessment of  the patient’s signs, symptoms, and results of various diagnostic tests.

Diagnostic Test Accuracy

Diagnostic test accuracy is simply the ability of the test to discriminate among alternative states of health (Zweig and Campbell, 1993).

If a test’s results do not differ between alternative states of health, then the test has insignificant accuracy; if the results do not overlap with other states of health then the test has perfect accuracy.  Most tests accuracies fall between these two extremes.

The intrinsic accuracy of…

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