Physician Rising: What It Takes to Get Up Again After Being Smashed Underfoot
Physician Rising: What It Takes to Get Up Again After Being Smashed Underfoot
This is the thirteenth in a series of articles about addiction treatment pioneer Dr. Punyamurtula S. Kishore and his ongoing battle with the Commonwealth of Massachusetts, which shuttered his fifty-two clinics in late 2011, dramatically increasing the state’s death tolls due to opioid addiction. Space forbids repeating the story developed in the first twelve articles. Readers new to this story are urged to catch up before reading on (links/references are provided at the end of this article).
It was noted at the outset of this series that Dr. Kishore had found far more respect and interest outside of the Commonwealth of Massachusetts, despite naming his revolutionary treatment method The Massachusetts Model. We’ll peer into the surprising new developments on this front at the conclusion of this article, developments which amount to powerful confirmation that “a prophet hath no honour in his own country” (John 4:44)—but does receive recognition elsewhere. So we turn now to setting the stage, providing additional context to let the truth stand out in sharper relief.
“For a Just Man Falleth Seven Times”
Those who have read all twelve previous articles in this series will be able to see that the entire scope of Proverbs 24:15–16 has played out in real life for Dr. Kishore. It is worth understanding this passage better before proceeding further. We provide Franz Delitzsch’s translation1 for the sake of clarity:
Lie not in wait, oh wicked man, against the dwelling of the righteous; Assault not his resting-place. For seven times doth the righteous fall and rise again, But the wicked are overthrown when calamity falls on them.
As Delitzsch notes, the righteous here “does injustice and wrong to no one,” being the one whom the wicked choose to target, “driving him by cunning and violence” out of what he has built.2 To head off misunderstanding of what is meant by the fall of the righteous, Plumptre makes clear that “the Hebrew word for ‘falleth’ is never used of falling into sin” but rather “into calamities” occasioned by such assaults.3 In the end, the wicked that laid siege against the just man will literally “stumble” and never again rise.4
But the meaning is deeper yet, as we see when Matthew Henry explains the schemes of evil men against the innocent (described in verse 15):
The plot is laid deeply: They lay [in] wait against the dwelling of the righteous, thinking to charge some iniquity upon it, or compass some design against it… The hope is raised high; they doubt not but to spoil his dwelling-place because he is weak and cannot support it, because his condition is low and distressed, and he is almost down already.5
The result is not what the plotters and schemers expected, however:
The righteous man, whose ruin was expected, recovers himself. He falls seven times into trouble, but, by the blessing of God upon his wisdom and integrity, he rises again, sees through his troubles and sees better times after them … The wicked man, who expected to see his ruin and to help it forward, is undone … his sins and his troubles are his utter destruction.6
In the course of the previous twelve articles, we’ve seen the remarkable achievements of Dr. Kishore and his pioneering work in addiction medicine, and the entirety of his life’s work being attacked from all quarters. This was a man compassed about with enemies, each in turn taking a vicious debilitating bite out of him. But now we are beginning to see the transition from the grim report of verse 15 to the brighter outlook of verse 16: the man upon whom those seven incapacitating blows had fallen has started to rise back up.
And what is that man facing as he’s rising again? What has happened in the nearly five years since the first blows fell upon him and his clinical practices? What has become of the political, cultural, and medical landscape in his absence? What’s happening in Massachusetts, and more importantly, what’s happening elsewhere?
A Policy of Scorching the Earth
Massachusetts proper is reaping what it has sown. The beleaguered governor’s policies make sense only if the focus is maintaining the appearance of doing something about the massively rising death tolls. The policy statements are empty because Governor Baker is appealing to a compromised, false source of “help”: the federal government:
Baker recalled hearing from Aaron Chick, a recovering heroin addict, who told the governor last week, “I know what to do when things are bad,” but “the piece that’s missing is what do we do after?”
“We have not figured that out,” Baker said Monday.
Baker suggested the federal government could play a bigger role around education and prevention with more funding for research of best treatment practices and training for prescribers.7 [Emphasis added]
The governor will not tell the truth and say, “The missing piece? Our state imprisoned the doctor who developed it and took away his medical license.” As bad as that is, his next suggestion is worse. The trust8 he reposes in the federal government for funding more “research of best treatment practices” has already been proven to be a dead end. In the twelfth article of this series, we showed how such federally funded research has been deliberately and fatally skewed to omit important treatment options from the testing matrix. Such research is being manipulated to rubber stamp the status quo solutions the nation’s drug czar favors.
I was provided with an advance copy of a letter being sent to JAMA (The Journal of the American Medical Association), written by a respected drug researcher (not Dr. Kishore), that would lead the reader to conclude that the severity of the drug problem is being downplayed through a similar process of distorting the data. The letter points out that a new 2015 study’s results were presented “in a manner that prevents readers from appreciating the full extent of the risk of long-term opioid therapy.”
The author illustrates how one 2007 study was wrongly included (it covered the wrong time duration) while two pertinent 2002 studies were inexplicably omitted. The DSM–IV definitions were used instead of the newer (2013) DSM–VM conventions, thus allowing two sets of numbers to come into play, one with an arbitrarily low range (0.6 percent to 8 percent). The author shows that 18 percent to 47 percent is the actual range supported by the studies.
This erstwhile researcher’s pending letter further points out how cancer patients and Tramadol users were improperly omitted from yet another key study, and that exit interviews of patients who said they felt addicted to their prescribed painkillerwere simply written off, skewing the results and further cutting the final numbers in half.
What we’re seeing is a scorched earth policy being implemented by faulty deployment of politically directed (and thus fatally muddled) science. How does one overcome the hard data supporting Dr. Kishore’s work? By deploying smokescreens in support of inferior treatment programs. Increased federal involvement will worsen the crisis because federal orthodoxy favors the replacement opioid therapies that are failing. Dr. Kishore has openly wondered why states with the highest treatment rates also have the highest death rates: which is the cause and which is the effect? Now that more people die annually of drug overdoses than firearms,9 that’s a fair question to ask.
The earth is scorched in another respect: you cannot wage war against rising drug deaths without counselors to bridge recovering addicts back to normalcy. Job turnover for addiction counselors in Pennsylvania are through the roof, reaching an “alarming 33% annual turnover rate.”10 Not surprisingly, the “addictions counselor shortage is felt more because of the increasing number of people dying from drugs.”11 How the nation’s drug czar, Michael Botticelli, proposes to wage a war with dwindling troops continues to mystify Dr. Kishore.
Transitioning from Scorched Foundations to Open Attacks
When scientific research has been hijacked to support political and/or business agendas, it’s the foundations of our culture’s safety net that are being scorched. Respecting the addiction counselor shortage, the loss of boots on the ground is indicative that the human capital (what there is of it) in the current fight is also being scorched, despite such counseling being foundational to resolving the crisis.
The foundations of medical practice itself have been scorched, and most readers will easily recognize how it happened by following Dr. Kishore’s description: originally, medicine recognized four vital signs (respiration, body temperature, blood pressure, and pulse). But an important addition has recently appeared: the one-to-ten pain scale, pain scales extending from smiley face to extreme misery, etc.12 Politicians and drug companies had essentially collaborated to create something new and dangerous, as Dr. Kishore explains the situation:
Chronic moderate pain—this is a category that should not actually exist. Pain is a symptom, not a diagnosis. It doesn’t exist in itself: there’s an underlying condition that should be diagnosed and treated. For example, acute pain is what we encounter as post-operative pain (there’s a gunshot wound: we find the bullet and take it out; there’s an infected appendix: we remove it; etc.).
But when OxyContin was approved by the FDA in 1995, a new market had to be created for this product. This gave birth to chronic moderate pain and the happy face scale. A proclamation concerning coal workers, etc., by the then-governor of Kentucky stated that pain should be treated, repudiating previous medical standards. OxyContin then came on-line in the Kentucky and West Virginia coal mines, and chronic moderate pain and its distortion of foundational medicine became entrenched.13
But open attacks on key components of Dr. Kishore’s method have also arisen. None are more dangerous than the attacks on home detox, because there is no more effective method than home detox for reasons its detractors refuse to accept. As Dr. Kishore explains,
The detox method has to have a scientific basis. All the addicted person’s triggers and cues are manifested in the home detox scenario: they’re not being masked, nor should they be. We need to help the patient through the process of cue extinction. You overcome by confronting the cue at home, which gives the patient a sense of power over the drug. No masking of cues: you must extinguish the cues. This can only be done at home, where the cues are present, not in a top-of-the-mountain detox experience elsewhere. The family connects with the patient because the addict doesn’t run off to get his drug of choice: he’s staying home because he’s not entering withdrawal symptoms.14
But where does one go once one has publicly rejected Dr. Kishore’s Sobriety Maintenance and Sobriety Enhancement approaches and heaped mindless abuse upon home detox (notwithstanding its huge success rate under Dr. Kishore’s oversight)? In response, The New York Times essentially scorches the remaining earth with its March 23, 2016, headline, “Ithaca’s Anti-Heroin Plan: Open a Site to Shoot Heroin.”15
Small wonder that the day before that headline appeared, The Blaze ran its opioid abuse story with an equally telling headline, “Slaughter Out Of Control.”16 As noted repeatedly in earlier articles in this series, the national drug czar, Michael Botticelli, insists on pouring more gasoline on the fire.17 If you’re selling such gasoline (replacement opioids), you have a good friend in Mr. Botticelli. In fact, your program will win White House awards18 to support current mythologies by diverting attention from the rising death toll.
This brings us back to home detox and why it takes a full twelve months to imprint sobriety back onto an addicted person’s life, as Dr. Kishore explains it:
All of us need endorphins—natural opiates. But if you’re supplying opiates from outside, what’s the point of making natural opiates (endorphins)? Those factories shut down in the body. It takes ninety days to retool the physiological systems to restore natural opiate production. In other words, the addict needs ninety days of a drug-free state.19 This resets the physiology, BUT it doesn’t deal with the psychological factors in the so-called seasonal cues (memories that rekindle throughout the year). All cues throughout the entire year must be extinguished and only home detox, properly administered, covers this ground.
In effect (and likely by design), the attack on the innocent described in Proverbs 24:15 with which we opened this article is inadequate to tell the whole story. Beyond the takedown of Dr. Kishore’s clinics and subsequent disappearance of his treatment model detailed in the earlier articles, the steps we’ve just outlined go further. Such actions find a stunning historic parallel in Rome’s first century assault on Jerusalem, in which the Romans reportedly plowed the land under with salt to prevent crops from growing on it. Scorched earth policies entail salt-poisoned soil.
But Proverbs 24:15 doesn’t stand alone. It is complemented by verse 16: the innocent man, though knocked down seven times, still rises again.
Those familiar with the Academy Award-winning movie Chariots of Fire will recall a scene (based on an actual event) where Eric Liddell is knocked down near the beginning of a foot race. Having now been dealt a huge setback, Liddell gets back up to pursue the pack of runners racing away from him. Remarkably, he overtakes the field and is first to break the tape, confounding the received wisdom that he had been knocked out of the race.
We seem to be witnessing something very similar to the above scenario.
Sadly, there are more parallels than those between Liddell and Dr. Kishore. In the film, just moments before that stunning race began, Ian Holm’s Sam Mussabini is given a choice line to mutter concerning the event: “I’ve seen better organized riots.” And the state and national responses to drug addiction (the latter under Michael Botticelli’s benighted watch) continue to richly earn that epithet.
But once Dr. Kishore was permitted to travel20 outside of Massachusetts (thanks to the dedicated efforts of Hal Shurtleff on the doctor’s behalf), the process of recovering from the blows leveled against him, his model, his track record, his medical license itself, began in earnest. Doors are opening in other New England states (and beyond). Dr. Kishore traveled to Maine in mid-March with Mr. Shurtleff and tells the story in his own words:
I spent four days in Maine and even attended a homeschooling convention there. There’s a groundswell of interest. Addiction rates are very high there. I spent an hour and a half with the governor’s key aide. They like the sobriety-based model. The governor himself will meet with me the first week of April. Maine has a strong homeschooling movement and her pastors are serious people. Maine’s governor is willing to do what’s necessary to get things done.
I ask Dr. Kishore if Maine could license him to practice medicine. He is understandably guarded in his words:
Yes, but I’m building this up slowly. I can’t rush it. I need to study the system that’s set up there. But if nothing else, it appears that the Massachusetts Model will not die.
There are other states and groups keenly interested in Dr. Kishore’s work and in ways to apply it, extend it, and/or rekindle it. Perhaps most remarkable of all is the following news Dr. Kishore shared with me:
I received an invitation to submit an abstract to the CDC (Centers for Disease Control) concerning the National Library of Addictions [see the third article in this series]. I’ve done presentations for the CDC before. God willing, I’ll be presenting in August of this year.
As heartening as these reports are, you’d be mistaken to think that Dr. Kishore is fully up and running again. While runner Eric Liddell took a tumble off the track, Dr. Kishore was deliberately kicked off the track, with brutal steps being taken to keep him out of the race and impoverished and destitute. We are now witnessing the process of his picking himself back up off the ground, with his eyes on the mark set before him. In Matthew Henry’s words cited earlier, “by the blessing of God upon his wisdom and integrity, he rises again, sees through his troubles and sees better times after them.” Or as Dr. Kishore put it, “The land has been tilled. The time is right for new models of care.”
This man has no time for self-pity. He has a race to run and countless lives hanging in the balance.
First 12 Articles in This Series:
1. Keil, C.F. and Delitzsch, F, Commentary on the Old Testament (Grand Rapids, MI: William B. Eerdmans Publishing Company, reprinted 1982), vol. 6, section 2, p. 135.
2. ibid., p. 136.
3. Rev. Professor E. H. Plumptre, in F. C. Cook, editor, The Bible Commentary (Grand Rapids, MI: Baker Book House, 1981 [1871–1881]), Vol. 5, pp. 594–596. Says Plumptre, “The latter of these two verses is so often carelessly but wrongly quoted as a half-apology for sin, ‘The righteous falleth i.e. sinneth, seven times a day,’ that it is necessary to put its true meaning in the clearest light possible … ‘Though the just man fall (not into sin, but into calamities), yet he riseth up.’” J. W. Nutt makes this same point: the just man “falls into trouble (not sin, as is often supposed).” Cf. Charles John Ellicott, Ellicott’s Commentary on the Whole Bible (Grand Rapids, MI: Zondervan Publishing Company, n.d.), vol. 4, p. 343.
4. John Peter Lange, Commentary on the Holy Scriptures: Proverbs (Grand Rapids, MI: Zondervan Publishing Company, n.d), p. 208.
5. Matthew Henry, Matthew Henry’s Commentary on the Whole Bible (Mclean, VA: MacDonald Publishing Company, n.d.), vol. 3, p. 932.
8. Many politicians are getting on the federal bandwagon, including mayors of major cities such as Orlando, Florida. Cf. http://www.orlandosentinel.com/news/politics/political-pulse/os-mayor-jacobs-calls-for-federal-help-against-heroin-20160322-story.html
13. During the discussion in which Dr. Kishore explained this, one listener quipped that such nonsense would eventually reduce to an absurdity on the order of “Hey, girls, have premenstrual cramps? Start a morphine drip—we’ll show you how.”
14. See the first two articles in the series for details concerning how Dr. Kishore intuited a simple solution to all the cues he’s uncovered over years of study. The example he provided in this conversation was the common nausea cue: “I provide anti-nausea medication in place of the drug. The guy wakes up the next day and says ‘Hey, I feel good this morning. I don’t need the drug.’ He’s waking up in the same bed where morning nausea would trigger his search for his drug of choice.”
17. Heroin is like a knife in a person’s back: how to treat it? Methadone and Suboxone® are simply replacement knives to stick in the back. If such knife replacement threatens the business of the dealer who provided the first knife, he might go so far as to report the replacement knife provider and have him prosecuted (as has actually happened). What nobody talks about is removing the knife and making it possible for the wound to heal over the course of a year, as Dr. Kishore’s method articulated.
19. Dr. Kishore adds, “This fact is recognized by Alcoholics Anonymous in their position that if one goes to ninety meetings in ninety days, one is home free.
20. He is now able to travel to all fifty states. This is remarkable, Dr. Kishore says, given the powerful interests still intent on keeping him muzzled and sidelined.
Martin G. Selbrede is Chalcedon’s resident scholar and Editor of Faith for All of Life and the Chalcedon Report.