Dr. Punyamurtula Kishore in the Eye of the Storm
Dr. Punyamurtula Kishore in the Eye of the Storm
This brief update is the fifteenth in a series of articles about addiction treatment pioneer Dr. Punyamurtula S. Kishore and his ongoing battle with the Commonwealth of Massachusetts, which shut his fifty-two clinics in late 2011, dramatically increasing the state’s death toll due to opioid addiction. Space forbids repeating the story developed in the first fourteen articles. Readers new to this story are urged to catch up before reading on (links/references are available at the end of the web version of this article).
We are now poised on the edge of several key developments in the unfolding story, which we will share once their full impact evolves over the course of the final two articles in this series.
Safer Than Abstinence?
The politicized medicine being promoted by The Boston Globe took an abrupt turn into madness on July 23, 2016. In the course of an editorial promoting more methadone, the writer, citing the consensus of “most addiction specialists,” makes the assertion that Medication-Assisted Treatment (MAT), of which methadone “is the most commonly used,” is safer than abstinence.1
Let’s be clear what the editorial staff at the Globe (which has been implicated in former Attorney General Martha Coakley’s campaign against Dr. Kishore) has just done with the stroke of a pen. In one sentence, we have taken sobriety off the table as unsafe. Safer to be on methadone or Suboxone® than to be sober. Sobriety and abstinence have been thus rendered irresponsible options. Small wonder that the editorial starts out by chipping away at the renewed criticisms of methadone and Suboxone®. Perhaps there’s an implicit fear that what’s happening in Maine (whose governor has dared to rethink methadone) might make its way to Massachusetts, upsetting countless rice bowls capitalized by these specialist-approved programs.
Conspicuously absent from the discussion is any objective measurement of success in relation to the treatment of drug addiction. Further, Methadone’s deadly failures are routinely hidden by cooking the books to hide its dangers.2 As noted in earlier articles, success in Massachusetts during Michael Botticelli’s tenure there was measured by how many people were receiving methadone and Suboxone® (retention in treatment), not by the index of sobriety. The federal government trusted in this deceptive yardstick when it made Botticelli the nation’s drug czar, whose toxic policies are now being dogmatically imposed on the entire country. As illustrated in earlier articles, such policies spray gasoline on the fire; Dr. Kishore has every reason to believe they are at the root of the death counts now spiraling out of control.
A suitable memorial for the deaths directly tied to the brutal shutdown of Dr. Kishore’s treatment centers has already been captured on film by documentarian Joaquin Fernandez. Forcefully switching patients from Dr. Kishore’s Massachusetts Model to methadone and/or Suboxone® was a key factor in their deaths, giving the lie to which treatment is “safer.” The film footage of an eyewitness to these tragedies is nothing short of gripping. The human cost of promoting the ideas in this recent Boston Globe editorial is immense. The Globe staff doesn’t care.
Let’s back up a step and ask about those “addiction specialists” that the editors were hiding behind. Why is it that so-called addiction specialists have failed to come up with anything other than the current national disaster as their legacy?
Surely the shaky clinical foundation they rely upon has been a factor ever since Vincent Dole and Marie Nyswander first published their study on methadone in 1967.3 The reader is invited to examine the referenced paper, but is urged to keep in mind the seedy underside of the presented results as described by Dr. Kishore:
The Dole and Nyswander research was initially based on small sets of patients and wasn’t a double-blind study, compromising its scientific validity. To maintain patients on morphine had proven medically untenable. To safeguard their grant, they tried administering high doses of methadone to the remaining patients and called the “study” a “success.” Other eyewitnesses to the advent of such programs have disputed the rosy characterizations of those being treated.4
We’ve documented many reasons for the subsidized tragedy now in progress, the results of which appears to justify Dr. Kishore’s view that today’s “experts” are purveyors of snake oil without the benefit of objective media or academic oversight. But is there something intrinsic to how medicine was being conducted over the last half-century that led to the pandemic we see today?
Indeed, there is.
Experimental Medicine vs. Common Sense
Medical research is a highly regulated concern. Properly credentialed researchers, working under suitable institutional umbrellas, dealing with large samples of duly informed patients in double-blind tests with carefully applied controls, form the backbone of experimental medicine. To be doing such research (experimenting on patients) outside of this narrow framework is, in effect, malpractice. Doctors cannot just experiment on patients willy-nilly, or decide to do medical research on their unwitting patients.
Herein lies the reason why Dr. Kishore achieved such astonishingly high success rates in his treatment programs (as documented in the earlier articles in this series). Because he started with the sobriety-orientation inherited from the 19th-century Washingtonian Hospital, within the domain of primary care medicine, he was able to arrive at results without violating the strictures of medical research. How, exactly, was that possible?
In the first two articles in this series we illustrated the phases of treatment required to successfully lead the patient through a year of sobriety, navigating the relapse-heavy first month in ways never before intuited, moving through all the seasons in the battle for total cue extinction. How was this detailed map of de-addiction developed? It was developed by the mapmaker in ways that can only be described as old school. Dr. Kishore used low-tech primary care techniques to resolve acute problems threatening his patients’ march to sobriety. In so doing, he was able to deal head-on with all twenty disciplines5 involved in addiction (rather than operate within a very narrow field of specialization with its concomitant tunnel vision).
Dr. Kishore’s method reduces to one simple principle: see a problem, solve a problem. The problems were all solved through primary care (letting the physician be a physician). Resolving these problems removed each consecutive barrier to patients moving forward to get their lives back. The first article in this series documented examples of the various problems that the absence of addictive opiates inflicts upon patients, showing how each problem has a common sense solution (sometimes medical, sometimes social, sometimes personal, and sometimes environmental). By being hands-on in his approach to each patient as he gave them the tools to put their lives back together, Dr. Kishore essentially gained more meaningful results than formal medical research was ever able to muster in this context.
In effect, Dr. Kishore’s successes serve as an indictment of existing medical research models, since addiction research is currently bound by standards in the service of goals other than sobriety. That sobriety is even being taken seriously again (under the more controversial term abstinence, which has political baggage in related contexts) has necessitated the appearance of opposing editorials such as the squib published by the Globe. If the Globe doesn’t nip the anti-methadone mindset in the bud, people might trace the problem straight back into the halls of medicine itself, and perhaps discover connections between Big Pharma, governmental indifference, and media complicity that they were never meant to know.
This explains the aggressive tenor of The Boston Globe editorial: strong words, designed to persuade, shaped to instill faith in today’s “favored” treatment modes while hiding their deadly consequences. Also hidden (despite the media’s full knowledge of it): Dr. Kishore’s superior treatment successes. In lieu of telling the clinically proven truth concerning Dr. Kishore’s pioneering successes, the media played its part in celebrating the destruction of his clinics. Rather than extolling the work of one of their most committed physicians, the focus was on the doctor’s own personal via dolorosa, his forced march into the belly of the statist beast.
Making the Innocent Pay the Price of the Malefactor
I reviewed the MRI report from images of Dr. Kishore’s right knee taken on April 21, 2016, in response to pain in that knee. There is significant damage to the meniscus, which Dr. Kishore did not have prior to being put to work cleaning the streets of Boston as an inmate who was fully 65 years old at the time. As reported earlier, his first caseworker, who intended to release Dr. Kishore early, was overruled by superiors intent upon inflicting upon the doctor the maximum punishments the system could muster, both in duration and intensity.
X-rays taken in October 2011 through the offices of Dr. Dye initially failed to detect the shoulder injury sustained by Dr. Kishore during his arrest on September 20, 2011. In Dr. Kishore’s view, the actual extent of these painful injuries was never properly detected until MRI images were finally taken on January 20, 2015. That the damage the MRI images revealed was either triggered or exacerbated by his shoulders being braced tightly backwards for transport to the Medford State Police Barracks is hard to deny given that the painful symptoms began with that traumatic evening. That pain remains a continual reminder of the day he fell into the brutal hands of the state.
I finally heard the full story of that fateful night, the night of the doctor’s arrest, during the filming of a documentary about Dr. Kishore being spearheaded by filmmaker Joaquin Fernandez. It is to this development that we now turn.
Translating the Doctor’s Story to Film
Many of those who’ve felt the impact of this investigative series recognize that the story of Dr. Kishore’s historic successes, his coerced downfall, followed by his slow ascent toward full vindication, would be well suited to the documentary film format. Filmmaker Joaquin Fernandez has taken the Kishore story to heart, and we can now report that principal photography for such a project was completed in June 2016 in North Carolina. Corroborative footage will likely be shot later this year in Massachusetts with other eyewitnesses to the drama. But now that Dr. Kishore’s personal story has been properly captured on film, he’s been free to fully explore new opportunities (the most promising ones in respect to the state of Maine).
Aside from the footage taken of Dr. Kishore, the video shoot included a powerful interview with a former manager of one of the doctor’s clinics. These aspects of the video put a very human face on the life-affirming successes the clinics delivered in their prime, and the devastation left in the path of the attorney general’s scorched earth approach toward them in September 2011. It’s safe to say the government officials behind Dr. Kishore’s persecution never expected to have such gripping, unanswerable testimony finally make its way into the public square via film. I have received credible eyewitness accounts that some of those state officials simply flee when directly confronted with the consequences of their actions. But the likelihood remains that at the federal level, the implicated authorities plan to double-down against Dr. Kishore’s harm avoidance and keep pushing their harm reduction paradigm at full throttle. This Globe piece, by disparaging sobriety/abstinence and favoring MAT, is simply echoing our federal drug czar’s battle cry.
In the course of the filming, Dr. Kishore had occasion to draw a simple comparison between his model and czar Botticelli’s approach. Self-consciously modeled after the seven pillars of wisdom mentioned in Proverbs 9:1 (“Wisdom hath builded her house; she hath hewn out her seven pillars”), he laid out the seven pillars of Botticellian wisdom and the seven pillars of wisdom as Dr. Kishore developed them in the real world. A brief preview of these insights will help set the two approaches in proper perspective by way of stark contrast.
Two Very Different Sets of Pillars
The seven pillars of addiction policy as promoted by the nation’s drug czar, Michael Botticelli, have been discussed in previous articles. They can be summarized as (1) No Wrong Door. (2) Harm Reduction. (3) “Medication” “Replacement.” (4) Save Shots. (5) Banish Stigma. (6) Addiction is a “Disease.” (7) Citizen “Soldiers” & Citizen “Doctors.”
Dr. Kishore describes his opposing seven pillars of addiction policy as “sensible” in contrast to the czar’s ongoing prescription for disaster set forth above. There is no middle ground between the two approaches because Botticelli and Kishore are diametrically opposed at every point. Dr. Kishore’s seven pillars are (1) Home “Deaddiction.”7 (2) Sobriety Maintenance. (3) Sobriety Enhancement. (4) Lifelong Primary Care. (5) Adequately Trained Workforce. (6) Integrated Bio-Psycho-Socio-Spiritual Care. (7) Treatment on Demand.
Moving the burden of practicing medicine from the shoulders of doctors onto the shoulders of firemen, police officers, mothers, teachers, etc., using Narcan as a “save shot” has been discussed in earlier articles showing how the drug czar is inflicting massive dislocations in the practice of medicine. While Dr. Kishore’s approach extends the practice of medicine, Botticelli’s approach overthrows it, necessitating his continual hunt for scapegoats to blame for each month’s new record-breaking death statistics for both cities and states. That there’s also a continual hunt for more cash goes without saying, as documented by the Wheel of Death graphic appearing earlier in this series.
Will these two sets of pillars be allowed to compete toe-to-toe? Such a confrontation is being avoided by the status quo at all costs. This explains why the Boston Globe piece promoting wider use of methadone joins countless other media sources across the country in concerted support of the various Botticelli pillars. The media forms one of the gears of the Wheel of Death, and is acting consistently with its pecuniary and ideological interests (but not its moral interests).
Dr. Kishore, doing the best medicine he knew to do for his patients, now finds himself in the unenviable shoes of the prophet Amos. The leaders of ancient Israel complained that their nation could not bear the words that Amos was speaking: his ideas were a threat to the established order (Amos 7:10). Amos was ordered to shut up and speak no more against that established order, because the sanctuary and the court belonged to the king himself (Amos 7:13) and no independent authority could be allowed to challenge state prerogatives. Were similar edicts allowed to play themselves out in our day and age in the realm of medicine, we’d see intimidating gag orders8 being inflicted on the pertinent witnesses. That may yet come; for it remains to be seen what someone with the authority and title of “czar” might conceivably do to protect his many rice bowls.
Consequently, Dr. Kishore’s situation is still tenuous and fragile. Despite every ray of hope (he was provided an office in Maine to start working on that state’s addiction problems with courageous sobriety-minded Gov. LePage) there remain ongoing difficulties and shortfalls. It is a difficult climb out of the hole that Massachusetts intended to keep him in. For those inclined to provide the doctor with much-needed assistance in his journey, you can send your donations to The National Library of Addictions, 535 Clinton Road, Chestnut Hill, MA 02467.
First 14 Articles in This Series:
2. Dr. Kishore points out that methadone deaths are labeled as deaths due to poisoning. By not being counted as illicit overdose deaths, the statistics get split and masked, allowing Botticelli to boast he has reduced overdose deaths whereas they’re actually going up. Equally egregious is how deaths occurring while the patient is being cared for at so-called Methadone centers result in the deceased being labeled “treatment resistant” or “a bad patient,” shifting blame onto those with no voice to absolve current policy of liability.
4. Correspondence from Dr. Kishore to M. Selbrede dated July 30, 2016. As one informed observer pointed out to the doctor, “The reservoir of addiction disease is what is maintained by these programs rather than eradicated. The patients often never recover fully. They remain addicted for life. And they don’t live that long.”
5. The twenty disciplines, as disclosed in the first article in this series, are primary care, behavioral sciences, psychology, psychiatry, sociology, social anthropology, criminology, criminal justice, law, forensic sciences, public health, social work, management sciences, psychopharmacology, clinical pharmacology, toxicology, occupational medicine, genetics, government policy, and behavioral neurology.
6. That there is some rhetorical artifice in arriving at the number seven can be granted. It’s more important to examine the substance of the pillars Dr. Kishore has defined than their precise number or relationship to the pillars alluded to in Proverbs 9:1.
7. Home deaddiction is another term for Dr. Kishore’s award-winning home detox program.
8. Note that attempts to publicize legitimate research showing the gender-bending side effects of methadone is routinely demonized as “irresponsible,” creating a virtual gag order enforced by public shaming of researchers. Pioneering peer-reviewed papers that dared to broach this subject were cited earlier in this series.