Puncturing the Boundary Between Medicine and Politics: How the State Condemns Addicts to Disaster
Puncturing the Boundary Between Medicine and Politics: How the State Condemns Addicts to Disaster
This is the eleventh in a series of articles about addiction treatment pioneer Dr. Punyamurtula S. Kishore and his battles with the commonwealth of Massachusetts. The grinding power of the state’s machinery shuttered this Christian doctor’s fifty-two clinics in late 2011, casting his patients back on inferior (and statistically death-increasing) treatments. Rather than export Dr. Kishore’s superior treatments, Massachusetts effectively crushed those results and exported the miserable status quo treatments in the person of Michael Botticelli, acting Drug Czar for the United States of America. Now all Americans are being afflicted with Big Pharma snake oil.
Again, space forbids repeating the story developed in the first ten articles in this series, and the reader new to this story is urged to catch up before reading this (see links below to the previous articles in this series). Once you grasp Dr. Kishore’s achievement with the 250,000 patients that have passed through his clinics (achieving success rates 7.5 to 30 times better than the existing treatment programs, based on hard testing data, viz., actual clinical results), you will better understand the disaster that Massachusetts continues to inflict upon its own people, a disaster it has exported to the federal level to spread the same damage nationwide.
In passing, we must note that hardly any projected dates concerning Dr. Kishore’s journey through incarceration have actually been honored by the authorities. The December 10, 2015, projected release date may be just as burdened with frustrating delays as all earlier milestones have been. But for those following the personal side of this story, December 10 may prove to be what it is advertised to be. We will pick up that trail in the twelfth article once the dust settles. Our concern in this eleventh article, however, will be upon the bigger picture, the drug addiction hurricane swirling around Dr. Kishore, who continues to observe this national crisis from the eye of the storm.
Post-Kishore Massachusetts: Climbing Death Rates
During the two years in which this story has unfolded, mounting evidence has proven two irrefutable facts.
(1) Prior to the state destroying Dr. Kishore’s fifty-two clinics, the death rates from opioid usage were neither growing nor static, they were dropping according to official state documents. From 2006 to 2010, the deaths had actually dropped by 15 percent, most of the drop occurring in the communities where Dr. Kishore’s clinics were located. His program was graduating people from addiction to sobriety. Men and women got their lives back and re-entered society as productive individuals, many even spiritually transformed as a result. The numbers tell the story: 50 percent to 60 percent of his incoming patients were still sober after one year under his treatment program, compared to 1 percent to 5 percent for all other (status quo) programs run by every other “treatment” center.
(2) When his program was shut down and the clinical evidence from his 250,000 patients subjected to an implicit media blackout, death no longer considered taking a holiday in Massachusetts: death started working overtime and expanding his fatal reach, especially in towns where Dr. Kishore’s clinics had been shut. Cui bono (who benefits) from this? Big Pharma. In the meantime, dead men tell no tales … unless someone undertakes to tell their story for them.
Scientific American reported that between the year 2000 and 2013, heroin overdose deaths have nearly quadrupled. Since at least 2013, deaths from drug overdoses nationwide have exceeded car crash deaths, and have also exceeded firearms deaths. The crisis is real. 60 Minutes put a human face on the spread of the plague in America’s heartland. A Nobel-prize winning economist collaborated on a study of CDC data showing the big killers for a major Middle America demographic aren’t heart disease and diabetes, but substance abuse and its corollaries. The Wall Street Journal cited a New Hampshire poll indicating that citizens rank drug deaths as more important than jobs and the economy as a campaign issue for Presidential candidates to address.
Propaganda You Can Take to the Morgue
In an interview with Botticelli published November 13, 2015, John Lavitt says the nation’s Drug Czar (who prefers to be called the Recovery Czar) “has helped advance and transform the drug policies of the nation in light of healthcare reform and a new emphasis on evidence-based treatment options.” Then why was the massive evidence supporting Dr. Kishore’s achievement (extolled elsewhere by experts in the field) completely omitted in Botticelli’s “transformation” of national policy?
Lavitt further says that Botticelli “has been an active proponent of innovations in prevention, criminal justice, treatment, and recovery.” But we’ve rehearsed evidence in this series pinpointing Botticelli as an active opponent of innovations in treatment, specifically, Dr. Kishore’s achievement in Massachusetts. While Botticelli headed up state drug policy for the state, he reportedly discredited the doctor to the media by acting as an unnamed news source.
Michael Botticelli is no slouch at playing the blame game. Dr. Kishore has collated thirteen different examples of the czar’s finger-pointing, a list which is stunning in how it underscores the shift of blame away from the czar’s catastrophic policies. The czar seems to have adopted the notion that the best defense is a blistering offense, and nothing diverts attention like crisis mongering.
The Governor Wisely Bolts … But to Where?
Massachusetts governor Charlie Baker made clear that he doesn’t want to preside over 3,500 opioid deaths a year, calling for some kind of disruptive technology to change the playing field: “This requires disruption, disruption.” At the time the governor made these announcements, the innovator behind the only clinically proven disruptive treatment for drug addiction was being paid three dollars a day to sweep the streets of Boston alongside other prisoners.
But any change governor Baker makes amounts to a vote of no confidence in what Michael Botticelli left behind in Massachusetts; and Botticelli has been willing to publicly oppose Baker’s proposals. There may be more to this than merely a kneejerk reaction: one of Baker’s proposals involves letting hospitals “hold substance-abusing patients against their will for up to 3 days.” Why should this be significant? Because Baker would be vindicating Dr. Kishore on the very matter the board of medicine condemned him for (putting the safety of his patients first). Such a move stands to reopen a case the authorities want to see forever closed.
The Spreading Flame
Massachusetts statistics are in a state of flux, with death rates being revised upward and the state’s per capita federal Medicaid costs the highest in the nation (with the least to show for it). Even earlier reports (since revised upward) are clear that the policies in place in Massachusetts have failed, tarnishing Botticelli’s “legacy,” although President Obama doubled-down on his commitment to such failed treatment programs for the nation at large. Other New England states are seeing similar problems, and so is Pennsylvania. Dr. Kishore finds Maine’s governor to be moving in a positive direction in the face of headlines such as “Heroin killing more Mainers than ever.” Rhode Island is unknowingly following at least one precedent established by Dr. Kishore’s clinics: focusing attention on the geographic areas worst affected by opioid abuse. Status quo treatments dominate the rest of the Rhode Island program, unfortunately: bad solutions applied in the right places will never lead to success. Although Rhode Island is ahead of Massachusetts in geomapping, the results will remain grim.
The Deadliest Blackout
Consider not only the 95 percent to 99 percent one-year recidivism rate of today’s programs (which have their own concomitant death tolls) but also the death rate inside today’s detox programs. Even foreign journalists are aware of the American problem and report it with embarrassing clarity. Because these deaths occur within accepted treatment programs, they’re overlooked.
Compare these records to Dr. Kishore’s clinics: of the 250,000 people that have passed through his treatment centers, not a single one died while under the doctor’s care. Not one, despite the strident false accusation that Dr. Kishore is a killer because he doesn’t prescribe methadone, etc. Here then is another facet of Dr. Kishore’s success that must also be suppressed and struck from the public record. How best to protect programs that kill than by burying evidence of the one program that didn’t? When state officials speak of “a problem that seems to be growing by the day with no real solution in sight,” that’s because the elusive real solution has been buried as far out of sight as Jimmy Hoffa’s body.
There is at least one serious attempt to launch a treatment program that, while unnecessarily reinventing the wheel that Dr. Kishore had been perfecting, is at least pointed in the right direction by leveraging primary care medicine. These innovative clinics are located in Baltimore and have broken away from the pack, bolting in a different direction. If they follow the data and refuse input from Botticelli, they may one day arrive at Dr. Kishore’s level of success. How tragic that they have to start from scratch because the true gold standard in addiction treatment developed in Massachusetts has suffered a total media blackout. This blackout is malicious in two ways: malicious against Dr. Kishore in personal terms, and malicious against those who are even now dying as a result of the blackout. The mounting death toll is a tragedy that not only Michael Botticelli must answer for, or Martha Coakley, but also the key enabler for these rising mortality rates: the Boston Globe. Pay no attention to their front-page handwringing: there is not one iota of sincerity in any of it.
What About Doctors Who Become Substance Abusers?
In terms of public health, no other program has been as successful as Dr. Kishore’s Massachusetts Model with its two-pronged focus on sobriety maintenance and sobriety enhancement. Prior to the program’s destruction, it was more than three-quarters of the way to achieving the kind of success rates hitherto only available to doctors who were being treated for substance abuse. Treatment programs for doctors are nothing like programs available for you and me. In 2009 the Journal for Substance Abuse Treatment reported success rates for doctor treatment programs where 78% still tested clean after five years and 71 percent were still employed after the same period of time. Dr. Kishore’s model, using a fraction of resources, brought the kind of care only known to afflicted doctors into the lives of regular people. For as it turns out, when physicians become addicted, they don’t enter methadone treatment programs. Like congressmen who don’t participate in Social Security or Obamacare, doctors know exactly what they’re doing.
Bearing the Expense of Substance Abuse
For there are societal costs to this crisis, and some researchers have gone so far as to quantify them. A study published in March 2011 calculated the national cost for opioid use in 2007 to be $55.7 billion, a number the researchers asserted would rise. A portion of this money is funneled into failed treatment programs to prop them up and capitalize Big Pharma. When the societal costs increase, and alternatives to methadone and Suboxone® are kept at bay, more capital is funneled into Big Pharma’s coffers. If you believe clinical studies aren’t tainted by the influence of pharmaceutical companies, Scientific American has proven otherwise, uncovering “hidden conflicts of interest and financial ties to corporate drugmakers.”
Border Skirmishes between State and Medicine
One way to increase state intervention and control in medicine is to call into question the legitimacy of primary care as an avenue for resolving substance abuse. The process involves the migration of this issue from primary care to specialized addiction treatment leading to state usurpation of medical prerogatives to stem the rising tide of resulting deaths. This entire process would be brought to its knees if a primary care approach to addiction were shown to be superior to the accepted specialty paradigm. If your goal is increasing state control over medicine, your enemy is any privately innovated success in the primary care arena. Any host who becomes wise to attached parasites will cast them off. The host must therefore be kept ignorant of all options other than state-sanctioned ones.
Dr. Kishore had felt it time to join the national dialogue on drug addiction in the course of this eleventh article’s development. But our problem is more fundamental: we’re not having a national dialogue. We’re having a national monologue. There’s a dialogue only when actual alternatives are on the table. There’s no dialogue when the one meaningful alternative has been destroyed. The best way to keep that life-saving alternative dead and buried is to revoke the medical license of the doctor who developed the alternative, and keep him burdened with new persecutions.
The first law of politics has always been “whatever the government touches, it ruins.”
Covering up the ruinous results entails the use of weasel words and deceptive technicalities. When Mr. Botticelli extolls medical treatment for substance abuse, he sounds like he’s pro-medicine. But “medical treatment” is a code word for death-dealing methadone and Suboxone® strategies, which stay pegged at huge recidivism rates guaranteeing increased mortality rates. Botticelli, a non-doctor, is dictating what doctors nationwide need to do: get on board with devastatingly bad treatment programs that line Big Pharma’s pockets.
As in the story of the emperor’s new clothes, somebody inevitably sees things as they really are. Dr. Kishore’s voice doesn’t carry beyond the confines of the halfway house he’s in, but Governor Charlie Baker has a significant bully pulpit. By lurching away from the system inherited from Botticelli’s tenure in Massachusetts, the governor instinctively knows he’s been sold a bill of goods. But being unaware of the alternative, he’s striking out in different directions out of desperation, thereby unwittingly accelerating Botticelli’s efforts to puncture the boundary between state and medicine.
Baker’s proposal to legislate what doctors can and can’t do for their patients exacerbates the problem rather than solving it. Baker has rightly lost faith in what he’s inherited from Botticelli. But he has wrongly lost faith in primary care medicine because he’s unaware that the answer lies in that direction – it’s merely been buried within the bowels of his state’s criminal justice system on false causes. It remains a mystery why the lieutenant governor hasn’t advised the governor concerning the proven results racked up by primary care medicine, as she presided over a public forum where Dr. Kishore presented his evidence on March 10, 2015 – a month before his incarceration.
Perhaps that’s not a story that state officials are willing to see publicized. They resist saying something honest like “the reason so many people are dying is because we did everything in our power to destroy the clinics that were successfully lowering the death rates here. Once those clinics were destroyed, the death rates and human misery climbed astronomically. Our actions blocked that addiction solution from being exported to the nation; instead, we gave the country Michael Botticelli. Misery loves company. Your tax dollars at work.”
The One Size Fits All Expired Prescription
Most people realize that prescriptions are fairly individualized things: they’re for a certain person and they have an expiration date. If you or I try to play games with prescription falsification, we’re likely to stand in front of a judge to answer for it. But when the state decides to play doctor, these pesky details can be trampled underfoot to make way for new paradigms. The story of Narcan®, the nasal spray administered to someone suffering from an overdose to pull them back from the edge of death, is an excellent example of this bureaucratic usurpation.
Signed on October 1, 2011 by Dr. Alexander Y. Walley, the standing order prescription for Massachusetts expired on December 31, 2012 – and yet is still referenced as the basis by which anybody can get Narcan® (aka naloxone), no questions asked. Rhode Island has a similar blanket prescription signed by Dr. Josiah Rich. On the dubious principle that no emergency should ever go to waste, the doctrine of informed consent for entire states has been abolished with a stroke of the pen. The situation state-by-state is fairly grim: a map published in July 2015 shows the nearly complete gutting of medical sanity in the name of deceptive new concepts like harm reduction, discussed and rebutted earlier in this series.
Informed consent has its complications, complications arising out of the importance of the idea. The presence of the physician, the patient’s medical record, sometimes even a witness, precede the voluntary giving of consent by the patient. All this is short-circuited by, for example, turning the mothers of addicts into surrogate doctors – and if disaster strikes due to her actions for her overdosed son or daughter, it’s her fault. But lucky mom: she’s immune from legal repercussions for having played doctor at the state’s behest. If she had no idea something awful could happen, that’s perfectly fine: like the dinosaurs, informed consent is extinct.
Puncturing the Wall between Medicine and State
Narcan® is being distributed statewide on an expired prescription to lay people, sober house owners can order urine tests without a doctor’s orders, and the Department of Public Health blithely approves laws without legal review. Some states now let pharmacists prescribe birth control with no doctor in sight. Why are we seeing these obvious erosions of the integrity of the medical enterprise?
The primary bulwark for insuring quality medical care has been the century-old Flexner Report, which reformed medical education in the U.S. by establishing verifiable standards for training doctors. It provides the framework for all matters medical. And if the medical profession isn’t broken, then there’s no need to fix it or abandon the Flexner standards.
But consistent statism holds to the idea that standards must be state-generated, not left to the professions to establish on their own. Instead of a profession controlling its own membership, the state takes the reins of control out of the profession’s hands. A good pretext for beginning this process helps expedite matters, and there’s no better pretext than a manufactured crisis. The dropping death rates the state was enjoying under Dr. Kishore’s tenure would have to be reversed to then grow a crisis that could spiral out of control and improve pharmaceutical bottom lines. One thing stood between the state and the medical profession: Dr. Kishore’s Massachusetts Model for treatment addiction.
When state overdose deaths were dropping, and Dr. Kishore’s success rates were trending higher year after year as he graduated people from his program, what did Massachusetts do to commend him for his life-saving work? What award did he receive for putting primary care medicine back in the center of addiction treatment, pushing inferior treatments to the periphery? The state innovated a medical version of Gresham’s Law (bad money drives out good money): bad medicine drives out good medicine. When bad medicine enjoys hegemony, the state looks heroic seizing control by puncturing the wall between medicine and state to then rescue medicine from itself. By federalizing the matter (with a national drug czar), controls can be imposed to keep good medicine far, far away. With media complicity, it’s easy for the state to control the narrative. What the state’s net doesn’t catch isn’t fish.
The strong horizontal integration of all aspects of treatment intrinsic to Dr. Kishore’s Massachusetts Model provided another bulwark against statist intervention in medicine. When each aspect becomes its own oligarchic silo (as is the case now), the state functions as the common cord gluing the silos together. Siloized medicine is the result of an implicit divide-and-conquer strategy. The cancerous growth of state intrusion is facilitated when the treatment ecosystem is atomized into separately regulated silos. The loss in efficiency is considered acceptable because control is the state’s paramount concern. Linking the silos is also financially profitable, further driving up the cost of medicine.
Why Does This Matter?
Let’s be clear: if Dr. Kishore’s treatment centers had been left unmolested, there’d be no need for a national drug czar. Even more importantly, addiction treatment would have been brought back under the umbrella of primary care medicine, strengthening the integrity of medicine as a profession. State intrusions into medicine would have been seen for what they are: superfluous and harmful.
If the rising death toll hadn’t been a factor in the Kishore takedown, state leaders would have simply been Luddites opposed to progress in medicine. But when the all-too-real lethal consequences of their actions are weighed, no verdict seems too harsh.
An agenda important enough to warrant losing thousands of American lives to achieve is an agenda worth understanding. It is an agenda birthed in the world of opioid and narcotic substance abuse. It is an agenda that couldn’t survive without destroying the Christian doctor pushing back that crisis better than anyone else. It is an agenda that dares to move ancient landmarks (Prov. 22:28) like the Flexner standards on the grounds that they’re inadequate to address today’s challenges. It is an agenda that unites drug companies, drug czars, government officials, and the media in support of its statist fictions as it spreads across the nation.
It is an agenda built on a lie erected over the grave of a truth it had a hand in murdering. And it is an agenda that might one day dig your own grave, or that of your loved ones.
The First Ten Articles in This Series:
See graph on page five of the Recommendations of the Governor’s Opioid Working Group, showing that prior to the Kishore takedown, the highest annual death rate occurred in 2006 with 615 deaths, dropping to 526 deaths in 2010. The clinics were destroyed in September of 2011 to prevent further reduction in deaths, and even then the death rate by year’s end was 603, still below the rate for 2006 and 2007 despite the clinics running only nine months out of twelve. Beginning in 2012, the graph shows Massachusetts opioid death rates skyrocketing as there was nothing in place anymore to prevent it. You will find the official government documentation of these facts here: http://www.mass.gov/eohhs/docs/dph/stop-addiction/recommendations-of-the-governors-opioid-working-group.pdf
Discussed in early articles in this series. The charge was made that Dr. Kishore lacked certification in addiction medicine. What was meant was that he didn’t have approval to prescribe methadone. This claim is wrong on multiple levels, but most significantly in this way: Dr. Kishore’s treatment doesn’t even use methadone – it is a non-narcotic method that yields vastly superior results to methadone maintenance. The criticism is malicious in both its misdirection and obfuscation.
1. Blaming Judges of Practicing Medicine without a License: http://www.huffingtonpost.com/entry/common-sense-wins-in-ny_560ae76ce4b0dd8503097d54
2. Blames Law Enforcement for Arresting Addicts for their misdeeds: http://www.nytimes.com/2015/10/31/us/heroin-war-on-drugs-parents.html?_r=0
3. Blaming Governor Baker for asking for involuntary treatment of Addicts: http://nepr.net/news/2015/10/20/white-house-drug-czar-skeptical-about-bakers-proposal/
4. Blamed doctors for not ordering urine tests for addicts and allowed Sober House operators to order the tests: https://botticellitopreventivemedicine.wordpress.com/2013/12/02/michael-botticelli-letter-to-preventive-medicine-associates/
5. Botticelli blames Drug Courts for not supporting his "Medication-Assisted-Therapy" euphemism for Methadone and Suboxone: http://www.huffingtonpost.com/2015/02/05/drug-courts-suboxone_n_6625864.html
6. Botticelli blames doctors for not prescribing ENOUGH Suboxone: http://www.huffingtonpost.com/entry/obama-administration-heroin_55fa058ee4b0fde8b0ccf192
7. Botticelli blames doctors for starting the Opioid Epidemic: http://www.huffingtonpost.com/entry/doctors-opioid-addiction_55e8e486e4b093be51bb10f2
8. Botticelli Blames Doctors for the Pain Pill Epidemic: http://onpoint.wbur.org/2015/10/06/fda-oxycontin-heroin-opioid-addiction-crisis
9. Botticelli blames lack of money as the reason for the opioid epidemic and believes money is the answer: http://pjmedia.com/blog/white-house-misses-mark-on-opioid-addiction-epidemic-says-phoenix-house-cmo/
10. Botticelli and team blame prescribed opioids for the Heroin Epidemic: http://www.etcada.com/events/heroin-abuse-increases-and-prescription-opioids-are-largely-to-blame-cdc
11. Botticelli Blames lack of Physician Education for Opioid Epidemic: http://judiciary.house.gov/_cache/files/80980670-6080-4230-968f-3d84c99cf258/boticelli-statement.pdf
12. Botticelli Blames Faith Community's ineffective effort for the Opioid Epidemic: http://www.pbs.org/wnet/religionandethics/2014/09/05/september-5-2014-heroin-faith-community/24028/
13. Botticelli Blames Stigma Attached to Addiction: http://mic.com/articles/128201/the-depressing-reason-presidential-candidates-are-finally-talking-about-drug-addiction
Unfortunately, Massachusetts governor Baker seems to be taking Botticelli’s thirteenth point seriously, rather than taking Dr. Kishore’s Massachusetts Model seriously. See http://commonhealth.wbur.org/2015/11/drug-misuse-stigma-campaign
Especially if you’re being called on the carpet for making racist statements. See http://www.theroot.com/articles/culture/2015/11/_gentler_war_on_drugs_for_whites_is_a_smack_in_black_america_s_face.2.html. Also troubling are Botticelli’s admissions of using marijuana and cocaine, which may have triggered further misdirection. See fifth from last paragraph here:http://www.vice.com/read/why-is-it-still-illegal-to-enter-the-united-states-if-you-admit-to-using-drugs-1102
The full quote by the governor was “I don’t want to be the governor who ends up presiding over 2,500 opioid deaths, or 3,000 in one year … or 3,500.” This was shortened by a Boston Herald editor into the form used in the main text of this article. See http://www.bostonherald.com/news/local_coverage/2015/11/baker_i_don_t_want_to_preside_over_3500_opioid_deaths_a_year
See Appendix A: Autopsy of a Medical Board Reprimand at end of this article: http://chalcedon.edu/research/articles/massachusetts-derails-revolution-in-addiction-medicine-while-drug-abuse-soars/
Dr. Kishore notes others working to integrate substance abuse into primary care medical practice, such as Jeffrey A. Buck: http://content.healthaffairs.org/content/30/8/1402.full.html
Journal of Substance Abuse Treatment 37:1 (2009), p. 1-7. See also http://www.sciencedirect.com/science/article/pii/S0740547209000373
See the tenth article in this series here: http://chalcedon.edu/faith-for-all-of-life/new-directions-in-christian-education/dr-kishore-encounters-the-dedication-of-the-state-2/
The rare exceptions to this rule have been duly noted in an earlier article: a few individuals do benefit from methadone. But prescribing it across the board simply pushes up the death rates.
See page 19 here: http://www.mass.gov/eohhs/docs/dph/substance-abuse/core-competencies-for-naloxone-pilot-participants.pdf
See page 3 and endnote 49 & 50 here: https://www.networkforphl.org/_asset/qdkn97/Pharmacy-Naloxone-Distributions.pdf
The deception extends to the previous endnote’s claim that the CDC declares 10,000 lives have been saved using Narcan® (naloxone). Who, pray tell, is reporting these administrations of naloxone? Recordkeeping is a sham when doses are being given by police officers and parents (meaning there’s little to no paper trail). Furthermore, what of people who receive Narcan® (a “life saved”) and fatally overdose a few months later: they’re still listed as a saved life! These overcooked metrics are used to sell additional dangerous drugs that sidestep the quest for restoring patient sobriety.
The Flexner Report’s birth was marred by concerns over racism. What has survived is the good it has done for the medical profession over the last century, despite the incidental impact upon black medical schools when the standards were first enforced.
For more details see: http://chalcedon.edu/faith-for-all-of-life/new-directions-in-christian-education/dr-kishore-encounters-the-dedication-of-the-state-2/
The state didn’t hesitate to demand this explicitly of Dr. Kishore: “We want you to close your labs.”
One irony of the Kishore prosecution was failure to recognize that his methods reduced costs: not only cost per patient, but cost to the state by graduating his patients into sobriety.
Martin G. Selbrede is Chalcedon’s resident scholar and Editor of Faith for All of Life and the Chalcedon Report.