Keeping Big Pharma in Seventh Heaven is Keeping Addicts in Hell
Keeping Big Pharma in Seventh Heaven is Keeping Addicts in Hell
How the State of Massachusetts is Moving the Goalposts in Light of Dr. Kishore’s Successful Treatment of Addiction to Provide Pharmaceutical Companies with a State-Funded Customer Base
This is the seventh in an ongoing series of articles about Dr. Punyamurtula S. Kishore, the Christian doctor who innovated the Massachusetts Model of addiction treatment. The previous six articles documented how conventional addiction therapies based on substitute narcotics (methadone and Suboxone®) leave only 2% to 5% of patients who won’t relapse back into full-scale addiction after twelve months. The few who haven’t relapsed will often take prescribed substitute narcotics indefinitely, creating life-long issues for them. In contrast, Dr. Kishore’s sobriety-based approach is non-narcotic in orientation. His method doesn’t lead to a miserable 2% to 5% success rate at the one-year mark, but an astonishing 50% to 60% success rate based on hard test data (rising from 37% in 1994 to over 50% in 2011 with a quarter-million patients having passed through his program).
Massachusetts buried this medical miracle by incarcerating Dr. Kishore in September 2011 and withholding Medicare payments to his fifty-two treatment centers, causing their complete collapse. The consequences of the state’s actions against Dr. Kishore’s work permeate the previous six articles. To repeat that material, even in condensed form, would consume most of this present article. If you’ve not followed this series, review the earlier articles (see below) before diving into this newest article. Without the background of the earlier articles, you can fall prey to ongoing manipulation (by omission and commission) by the state and its media gatekeepers.
Moving the Goalposts
The first example of “moving the goalposts” in this series had reference to the cleverly-edited graphic used to hide the disastrous 80% recidivism rate occurring during the first month of conventional drug addiction treatments. Because the first-month results have simply been chopped off the graph, they don’t come under consideration. This opens the door to redefining success. One moves the goalposts for one of two reasons: to block a competitor from succeeding, or to create the illusion of success for yourself. This tactic is a blatant example of the latter.
Moving of the goalposts in such a way can only be effective if you are ignorant of the correct location of the goalposts. If someone comes along and blows the whistle on how dislocated the goalposts are, and what constituencies are benefiting from the reality distortion field thus imposed, he becomes a threat. If the whistleblower’s success rate is many times higher than the conventional success rate, this becomes a second layer of threat. Both forms of threat to the status quo need to be quashed to maintain the blissful ignorance of the populace, to keep the goalposts at their “preferred” new location. When the media keeps the people it reputedly serves ignorant of both aspects of these moved goalposts, it becomes a key accessory to the redefinition of success. Once journalists start down that road, it becomes increasingly difficult for them to admit fault, recant, and fight against the ignorance they’ve been enforcing so faithfully. No one wants to admit culpability in moving the goalposts. Therefore, Dr. Kishore’s clinical record is simply ignored.
There are three other major respects in which crucial goalposts have been moved during the escalating drug addiction crisis taking its massive toll upon our communities. We will examine the tactics, significance, and high price we are all paying for the moving of these goalposts that should never have been moved. We will then come to understand why Solomon’s maxim remains painfully valid for us today: “Remove not the old landmark; and enter not into the fields of the fatherless” (Prov. 23:10).
Exporting Doctored Goalposts out of Massachusetts
The fifth article in this series dealt with the rise of Michael Botticelli from someone presiding over the ongoing drug disaster in Massachusetts to his promotion to overseeing federal policy on the addiction crisis at the national level. We predicted that Botticelli would persist in making the same mistakes as the nation’s drug czar that he made in Massachusetts (see article five for an examination of the part he played in discrediting Dr. Kishore’s clinical record so as to protect and promote the vastly inferior methadone and Suboxone® treatment regimes).
As noted earlier in this series, when we’re only allowed to see repositioned goalposts, we’re open to “success” itself becoming redefined in the battle against opioid drug addiction (comparable to the re-norming of the Scholastic Aptitude Test to hide declining student performance). We provided examples where local officials no longer speak in terms of sobriety or abstinence from addictive drugs: they now believe their sole job is to prevent addicts from hurting themselves. The shortcut route to that goal tends to focus on the administration of methadone and Suboxone®, usually indefinitely. Why indefinitely? Because “success” doesn’t mean sobriety or a drug-free productive life anymore, it now means “the addicts won't hurt themselves.” This lowering of the bar is, of course, a moving of the goalposts. We hide the massive failure that addiction medicine entails (with its pitifully low sobriety rates) by dropping sobriety measurements altogether from the picture.
Ironic it is that Dr. Kishore, who achieved the nation’s highest sobriety rates (60% and rising, compared to 2% to 5% for conventional addiction treatments), was accused of being a killer. Nobody ever died while under Dr. Kishore’s care (a rare case of a perfect record for someone who’d had a quarter million patients pass through his clinics). Why the accusation, then? Because of the prevailing dogma that sobriety-based programs that promote abstinence fail to stop people from hurting themselves, so that they relapse and die of an overdose or commit suicide (see the first article in this series concerning the breakdown of the first four weeks of treatment to understand Dr. Kishore’s success in more detail).
By manipulation of the facts, the impression is created that the good doctor is the one keeping his patients perpetually on methadone, while the bad doctor is the man putting their lives back on track, drug-free. The easily-disproven falsification of Dr. Kishore’s record served its purpose well. Asserting that “Dr. Kishore is a killer!” shifts attention away from the misery created by conventional substitute narcotic treatment programs. The claim needn’t be true to be effective.
Not one to let local officials do all the moving of goalposts, Michael Botticelli has chosen to elevate the “don’t let addicts hurt themselves” mantra to the level of national dogma as a treatment philosophy. Not surprisingly, he opened up the Tenth National Harm Reduction Conference in Baltimore in late 2014 to represent the current administration’s “progressive credentials.” He implicitly endorsed methadone and Suboxone® as the standard of care for addiction. These public actions were tantamount to kicking dirt into the open grave that Dr. Kishore’s sobriety maintenance programs were supposed to stay buried in, along with their paradigm-busting success rates.
One has to wonder how Michael Botticelli managed to rise to a federal position. Moving goalposts has a lot to do with it. Massachusetts has a massive addiction crisis, and with success commonly redefined as the number of persons in treatment programs (however ineffective they really are), Botticelli was seen as a man taking care of business. That his policies and philosophies only worsened the situation in Massachusetts was never considered, because the goalposts were moved. The federal government’s endorsement of the new goalpost location was the icing on the cake. Now Botticelli is threatening to withhold federal money from drug courts that don’t provide methadone or Suboxone® to individuals. Such courts will be penalized for upholding sobriety as the standard of success. In short, Botticelli is working overtime to penalize jurisdictions daring to choose a treatment that’s up to thirty times more beneficial to the patient (Dr. Kishore’s Massachusetts Model). This is the new progressivism, care of the new goalposts imposed on the issue.
Therefore, a primary legacy of Botticelli’s rise to power as the drug czar will be the redefinition of success in terms of harm reduction, not sobriety. With such sleight of hand, the destinies of millions of Americans have been written off by political shortsightedness. Sobriety will be regarded as inaccessible. We have the media to thank for their complicity in burying the truth of how accessible sobriety really is.
Moving the Legal Goalposts
As we await the results of the upcoming trial of Dr. Punyamurtula Kishore, scheduled for April 2015, we must note again that leverage against Dr. Kishore has been acquired chiefly through the moving of goalposts. Arbitrary state power in combination with the self-contradictory complexity of applicable law has rendered the “three felonies a day” in the title of Harvey Silverglate’s must-read book a routine phenomenon.
An appeal filed by Dr. Kishore’s attorney of record created an interesting situation, as many of the main media outlets didn’t publish the story, which was carried predominantly by relatively peripheral news sources. It is tempting to speculate that a growing drumbeat of support for, and awareness of, Dr. Kishore’s achievements may be motivating the main news sources in Massachusetts to be more circumspect and cautious in repeating claims made by the office of the attorney general. If true, this is a small but important step in the right direction.
Of those outlets that carried the story, it is significant again to see how public ignorance was leveraged to give a completely false impression of the prosecution of Dr. Kishore. One example will suffice for our purposes.
In response to the appeal to have the case dismissed, the attorney general’s office claimed that it’s too late in the game and that the trial has already been postponed nine times. The implication was that these nine postponements were due to the defense dragging its feet and trying to prevent the case from coming to trial. Not a single news outlet pointed out that seven of the nine postponements originated with the attorney general’s office, and that the two postponements requested by Dr. Kishore were related to treatment for his renal tumor, a medical reason. In every such instance of filtering the facts, the worst possible impression is always inflicted on Dr. Kishore. The defendant is depicted as slippery and evasive, the result of moving the goalposts on the theory that political need outweighs the facts.
Moving Medical Goalposts
As disturbing as the above developments are, the political redefinition of what constitutes the valid domain for medical practice is an even more dangerous one. For Dr. Kishore’s Massachusetts Model has brought primary care, and a broad cross-disciplinary approach, back to the table as the time-tested framework for the treatment of opioid addiction. The massive successes of his program, reported in the first four articles in this series, speak for themselves. He has established that primary care is the vehicle of choice for addressing this complex crisis, with clinical results that no other program has come close to emulating.
Dr. Kishore has reaffirmed the legitimacy of the primary care physician (when trained to apply his skills within the context of the Massachusetts Model) as the key to solving this growing health care epidemic. This achievement represents an end-run around the Johnny-One-Note solutions (methadone, Suboxone®, Narcan®, etc.) being promoted by pharmaceutical companies and those aping their talking points. The concept of the physician as an agent of healing in society lies at the core of Dr. Kishore’s achievement. The recovery of this concept and its vigorous application to the problem of patients with opioid addiction led to the development of the most successful drug treatment program developed to date.
When the prerogatives of primary care are reserved to the medical profession operating in terms of its original, unadulterated cultural charter, the preconditions for the kind of clinical successes that Dr. Kishore developed are readily met. How this unfolded in the creation of the Massachusetts Model was laid out in the first four articles in this series, giving rise to Sobriety Maintenance and Sobriety Enhancement, the keystone elements of Dr. Kishore’s work.
The new paradigms, willfully rejecting thousands of patient-hours supporting the validity of Dr. Kishore’s approach to sobriety maintenance, have moved the goalposts in two ways. The first way we’ve already discussed above: success is no longer defined in respect to sobriety. Sobriety has been written off and no longer counts. It is now a non-criterion for success. Harm reduction is the new sobriety, except it has nothing to do with sobriety and everything to do with keeping the populace addicted to substitute narcotics or worse.
But more insidious than redefining the meaning of success is redefining physicians out of the treatment equation entirely. Whereas in primary care, the family physician is the primary avenue for treatment under the Massachusetts Model (as augmented by the model itself, explained in earlier articles), treatment of the opioid epidemic today is routinely being taken out of the hands of physicians entirely. For example, the drug Narcan®, a nasal spray, is being positioned for non-doctors to administer (police officers, family members, etc.). Botticelli’s penalizing of jurisdictions that refuse to administer methadone or Suboxone® represents the federal government dictating treatment, notwithstanding availability of alternatives promoting sobriety to those state jurisdictions. The power to write prescriptions has been transferred from individual doctors to a pre-existing blanket prescription that can be invoked at will by state authorities (representing the future of healthcare in a nutshell).
These relocated goalposts are all saying the same thing: drug addiction is not the province of primary care physicians. To make this relocation stick, all remembrance of Dr. Kishore’s clinical achievements must be struck from public memory. To this day, no major media outlet commenting on his trial has ever mentioned his success rates and how he achieved them. When asked to comment on this astonishing aspect of the defendant they were prosecuting, the state attorney general’s office also declined to respond (see article six in this series).
What would happen if Dr. Kishore were acquitted and began to put his model back into practice, going against the flow of the new but clinically inferior paradigms being promoted while he was sidelined? Authority and responsibility would flow from state bureaucrats back into the hands of primary care physicians, who would be newly equipped to achieve and extend Dr. Kishore’s 60% success rates without losing any patients. The market for opioid substitutes would shrink to a tiny fraction of its current size, and the social costs for having so many people functioning at such miserable subsistence levels would be slashed.
Powerful interests tend to protect their rice bowls from being kicked over. The unprecedented overreaching by Massachusetts prosecutors suggests (but certainly does not prove) that there is more driving this ill-conceived case against Dr. Kishore than one reads in the heavily filtered media accounts of the trial.
Restore the Goalposts
Earlier we cited Solomon’s admonition, “Remove not the old landmark; and enter not into the fields of the fatherless” (Prov. 23:10). The fatherless (orphans) are the least powerful members of society, wholly dependent upon the moral capital of a society to preserve standards of justice and rectitude. Whenever landmarks or goalposts are relocated, we always see a parallel invasion across jurisdictional boundaries, one sphere (usually the state) expanding into the domain of another. The goalposts, the landmarks, are moved to publicly redefine and justify the boundary transgression as beneficial and moral. It is our system’s way of saving appearances. But such masks are becoming harder to maintain as the current epidemic rips this nation apart, inclusive of infants who are born addicted to opioids (the Massachusetts rate for such births being three times the national rate).
The goalposts were originally moved to hide massive failure afflicting conventional treatment methods. There is no reason not to restore the original goalposts in light of what Dr. Kishore’s primary care approach has achieved (doing so in the glaring light of hard clinical evidence that is incontrovertible). The only reason to protect failure and indict success is to provide manufacturers of substitute narcotics a massive state-funded customer base, ruined lives be damned. The price for keeping the pharmaceutical companies in seventh heaven is keeping the addicts in hell.
The First Six Articles in This Series:
Harvey Silverglate, Three Felonies a Day: How the Feds Target the Innocent (New York: Encounter Books, 2011). See the review of this book in the May-June 2012 issue of Faith for All of Life written by attorney Jerri Lynn Ward – see page 20 here: http://www.scribd.com/doc/91967171/May-June-2012-Faith-for-All-of-Life
The appeal pits federal regulations against state regulations, arguing that the federal regulations provide a rational scope while the state regulations do not. The appeal argues from the Fourteenth Amendment and supremacy considerations that the better-written federal regulations should apply, and doing so would automatically cause the case against Dr. Kishore to be dismissed. While we certainly have mixed feelings about using the Fourteenth Amendment in such a way, the resistance of the Massachusetts prosecutors to acknowledging the ambiguity in their law code surely suggests the possibility that ulterior state motives underlie this dispute over jurisdiction and authority.
Apart from the infamous Emailgate incident where Dr. Kishore’s email records were sifted by prosecutors (see article two in this series) and multiple incarcerations to keep him out of the public eye, we note the following developments, reported by this author in the December 2014 Chalcedon Report: “The courts of Massachusetts have finally removed the GPS bracket from Dr. Kishore’s ankle (a shackle he’s borne for three years) in acknowledgement that he is no flight risk whatsoever. Regrettably, his attorneys have repeatedly attempted to strong-arm him into accepting a plea bargain, which he has steadfastly refused to do. An attempt by his main attorneys to enter such a guilty plea, over Dr. Kishore’s explicit refusals to plead guilty, was narrowly averted by the swift work of his pro bono attorney, Harold Jacobi. A press conference assembled to announce that illicit guilty plea had to be called off once it was learned that Dr. Kishore had been able to prevail in maintaining his uninterrupted assertion that he is innocent and will continue to plead innocent. The state recognizes it’s on the hook for millions of dollars of cash owed to Dr. Kishore’s clinics should he prevail in court – and is thus motivated to throw its weight around to keep that cash in its own pockets.”
Martin G. Selbrede is Chalcedon’s resident scholar and Editor of Faith for All of Life and the Chalcedon Report.