The Pioneer Who Cut New Paths in Addiction Medicine Before Being Cut Down
The Pioneer Who Cut New Paths in Addiction Medicine Before Being Cut Down
February 13, 2014
Part 3 in a series about medical path-breaker Dr. Punyamurtula Kishore
In the previous two articles in this series, we contrasted the revolutionary achievements of Dr. Punyamurtula Kishore in the field of addiction treatment with the treatment given him in return by the state of Massachusetts. While conventional medicine achieves 2% to 5% sobriety after a year of treating addicts, Dr. Kishore's Massachusetts Model for Sobriety Maintenance was achieving a staggering 37% sobriety rate (as confirmed by actual hard testing). His approach was non-narcotic, treating the whole person with a life-integrated approach that distinguished between the various complex phases the addict goes through upon beginning detox. His 52 offices were closed in the fall of 2011 as the state cobbled together its specious case against him, which the state has yet to bring to trial.
The common refrain of the prosecution (a term that shouldn't be limited to the office of the Attorney General, but includes key players in the media) is that Dr. Kishore is a fraud. He is a fraud in every respect that someone can be a fraud. The two earlier articles established the absence of evidence for these claims, but there is much more that needs to be said.
The wolves circling Dr. Kishore rely on the "fraud" moniker to hem him in on all sides. Ironically, nobody has accused his 37% success rate as being fraudulent (apparently because they either don't know about this fact, or don't care if it's true or not). Trial-by-media requires a broad brush dipped in vitriol. Before we resume digging into the explosive legal aspects of the case in subsequent articles, we first need to examine one of the more extraordinary ways in which the judgment of "fraud" has been painted onto Dr. Kishore.
The National Library of Addictions
The National Library of Addiction was the brainchild of Dr. Kishore, its founder. Its existence has become a point of controversy. More accurately, its alleged non-existence is the point of controversy. As the media critics have mockingly pointed out, they've been unable to find any such library as the National Library of Addictions (hereafter the NLA). Therefore, it doesn't exist. The NLA is nothing more than a front to hide even more fraudulent activity by Dr. Kishore. That fraudulent activity is unspecified but nonetheless regarded as real, on the grounds that the library itself is unreal. The NLA is nothing more than a fabrication from the mind of Dr. Kishore.
Let's unpack this argument.
This attack starts with a definition: a library is a brick-and-mortar building that houses printed books. This is what the NLA is supposed to be, if it is a real library. But the NLA is reportedly not a physical library. In that case, we'd have to reply that the NLA is much better than a physical library, and does far more than a physical library ever could do.
By the critics' antiquarian definition, we'd have to also conclude that Wikipedia isn't a true encyclopedia. Wikipedia too is a fraud. Nowhere is its data printed and bound into books . But in the twenty-first century, we recognize Wikipedia as being an encyclopedia on steroids: it is dynamically changing in size, extension, depth, and (regrettably) ideological filtering. Technology has transformed the concept of the encyclopedia.
Technology has also transformed the concept of the library. The NLA takes advantage of the Internet to fulfill one of the major functions of a library: making important information accessible to those searching for it. In this respect, the NLA bears a functional similarity to Wikipedia. If this were all the NLA did, it would still satisfy any modern definition of a library so far as how it is housed and how its content is distributed.
However, the NLA does something that neither physical libraries nor virtual libraries do. In the case of a physical library or virtual library, the person acquiring the information needs to proactively visit the library (either by driving to a physical library, or surfing the Web to get to the library's content). The library in this situation is a passive entity: it is merely a repository of knowledge and wisdom. But to access it, you need to be active. You need to seek its contents, read them, discern what is useful, and apply it. But traditional libraries do not have an active outreach.
Enter Dr. Kishore, who blazed a new path in what a library should do.
The National Library of Addictions (as noted in the first article of this series) hires recovering addicts within his treatment centers to become NLA ambassadors. The ambassadors embody outreach in several different ways: they participate in key intervention processes as a living resource, and they provide important data to doctors-in-training who are trying to wrap their minds around the complexities of addiction medicine.
The concept of a human being as a living book within a virtual library, a book that is mobile, pro-active, and radiating useful life-changing information to those in need, isn't new. St. Paul makes this same claim for human beings being living epistles "not written with ink" that are of greater impact than conventional writings (2 Cor. 3:3). Such men and women are "known and read of all men" (2 Cor. 3:2). As living stones comprise the true temple of God, living epistles comprise the true library of God.
Let's assume Dr. Kishore did in fact build a brick-and-mortar library and filled it with books. Who would visit it? Doctors? Addicts? Will addicts swarm to this place and check out books? Will doctors do the same? Is this the right model for the Internet age? Or are the critics spouting nonsense here?
The earlier articles in this series emphasized that Dr. Kishore's approach is revolutionary: nobody was approaching addiction medicine like he was (although he stands within a long tradition of addiction treatment through promotion of sobriety). The NLA wasn't about to stock its shelves, virtual or otherwise, with content geared to modern status quo approaches to addiction treatment (what the critics are demanding). Dr. Kishore was reconstructing this entire field of medicine from the ground up.
And so Dr. Kishore created that trailblazing content, month-by-month, by writing articles for the Journal of the National Library of Addictions (JONLA). This library was intellectually bootstrapped by the efforts of a single man, and soon other doctors were contributing articles until the last JONLA appeared in October 2011 (Volume 8, Issue 10). These JONLA articles trace the complex byways of addiction and its treatment, articulating the birth and evolution of the Massachusetts Model, its background, and its extensibility. JONLA was a major achievement despite its modest origins because it provided the factual backbone supporting that 37% success rate (a statistic that Dr. Kishore was working to improve upon prior to the Attorney General's take-down). There were bigger journals, more prestigious journals, but nobody had a more important journal on this topic than Dr. Kishore. This library had gold on its virtual shelves.
This library also had gold in respect to its ambassadors, the "human epistles" that, unlike books on shelves, go to where they're needed to spread the truth. Each of the dozens of ambassadors has his own story to tell. Representative in this respect is Ms. Ulich (NLA ambassador between 2000 and 2008). Ulich had a list of criminal convictions sixteen pages long when she first met Dr. Kishore. She was on the run from the law. She's now gainfully employed and paying her taxes.
Ambassadors open up a new channel by which the success of the Massachusetts Model becomes self-reinforcing at the personal level. If you have a 37% success rate, you actually have such human resources available to you to build positive-feedback loops. The orthodox treatment alternatives (methadone and Suboxone®) built around narcotics really don't provide any human epistles worth reading (unless you're interviewing the leaders of Big Pharma). Sobriety makes for a much better living book than replacement therapies do, books that tell a better story, with a better ending, and doing so with integrity and credibility.
This is why we don't find a Methadone Library of Addictions, with ambassadors promoting the state bus passes that fund their rides to the methadone clinics. The orthodox treatments are promoted at the federal level, their advocacies trickling down to the states, which in turn adopt federally-created advertising slogans to push their comparatively ineffective solutions to the state's addiction crises.
The NLA: Much More Than a Traditional Library
The National Library of Addictions had to create content (written content in JONLA, human content in its living ambassadors) from scratch, because the Massachusetts Model was brand new. Nobody had done anything like this before. But there's even more to the NLA story.
Dr. Kishore's approach to sobriety maintenance raised the question, Who shall pay for social medicine? In answer to this challenge, he founded the NLA as a platform for moms and dads to form groups. This was just one of several ways, says Dr. Kishore, in which he "turned mothers into a fighting force." The NLA served an important function by being a neutral place in respect to the extension of treatment. This non-profit library was founded in 1993, becoming a trustee of good-faith contributions that it promptly spun back into improving treatment for addiction. The entire enterprise was designed to keep the collective responsibility of society out of the hands of the insurance companies, thereby reducing the drain on them which addiction incurs.
The NLA ran on a budget of $86,000 per year, the vast majority of which was donated to it personally by Dr. Kishore himself every year for eighteen years. He was still building up the NLA, the JONLA, and its ambassadorship program, at the time the state destroyed his practices, so the NLA was not yet paying its own way. What does this tell you about Dr. Kishore's motives in keeping the National Library of Addictions operational?
Imagine how different the world would be if more libraries had such life-changing, proactive outreaches as the National Library of Addictions had. Dr. Kishore's labors in operating this library were over and above all the massive work he put into his main addiction practice. (He had, in fact, visited nearly all 351 towns in Massachusetts.) The Library represented a huge sacrifice of both his time and his money. Just as he had reconstructed the foundations of addiction medicine, he also reconstructed the concept of a medical library, blazing new paths where no modern doctors had gone before.
The NLA is the only library in the world whose most important content is based on the most successful addiction therapy program ever developed. It is the only library in which living epistles spread its most precious content back into treatment programs (to help other addicts) and into the halls of medicine (to train doctors in the dynamics of addiction treatment).
But the media has already ruled that this library doesn't exist: the NLA is merely a vacuous delusion supported by cheaply printed business cards. That is how far journalists will do their research: just enough to be able to add the NLA to the list of frauds that Dr. Kishore should be condemned for propagating.
As noted in the first article of this series, the fourth week of treatment marks the phase when the addict is lonely, having been excommunicated from his social network. The easiest response to addicts' growing awareness of their grim prospects is suicide. They need a new identity. Like a newborn baby, they need that new identity to avoid recidivism. Just as physical factors (they can still detect the smell of drugs in their own hair and in their clothes) require physical steps to eradicate them, interpersonal factors require addressing that more complex dimension of the person as well.
Being an ambassador isn't easy. Addicts are introverted and shy. Public speaking is hard for them. They need to see value in their new family so that they will protect it with the same zeal they protected their first illicit group or enterprise. An ambassador must see the transcending value in what they are representing to be sufficiently motivated to overcome shyness. It is fitting, then, that NLA ambassadors are stipendiaries who are paid an honorarium for their work on behalf of the library.
Such approaches to these risky phases of the addict's progress are tantamount to providing a "group transplant" into an edifying scenario (where the addict is edified and in turn is an agent of edification). The orthodox treatment systems the state supports do not work to transplant addicts: the state merely abandons the addicts to the maze. If this proves unworkable, the state locks up the addict so they don't face any challenges. This is much easier than Dr. Kishore's approach of being a firefighter who stands with the addict as they work through challenges. The state, however, cannot be bothered to get its fingernails dirty.
Imagine what would be going through the mind of an NLA ambassador, a person who had been faithfully working with other addicts and had interfaced with physicians at major medical schools, upon encountering the story the media now tells. "There is no National Library of Addictions. It was a fraud concocted by that thief, Dr. Kishore." Not only is the Library discredited with such libelous statements (whether overt or insinuated), the ambassador is also discredited. His or her achievement is asserted to be a delusion, and their NLA position was a meaningless token job at best, a noxious fraud at worst. What dangerous repercussions for these former addicts could emanate from this toxic atmosphere arising from media complicity with statist thuggery?
We must conclude that in Massachusetts it has become increasingly more difficult to legitimately use the words "responsible" and "journalism" in the same paragraph, let alone in the same sentence. That's not only due to the factors above (bad as they are), but to the fact that the National Library of Addictions actually IS a physical library housing 10,000 books in three locations, locations that have been posted on the web for years.
The Physical Library That Supposedly Doesn't Exist
Founded in 1857, the Washingtonian Hospital (aka the Washingtonian Center for Addictions) ran continuously until 1980, when Dr. Kishore inherited a portion of its library, to which he has since added countless books in many disciplines. The growing collection came to occupy an entire floor of his Brighton practice by 1996, where the library became a venue for hosting various educational groups (e.g., attorney Jonathan Delman's Addiction Law Forums). That same year the library began to hold conferences (Addiction Medicine 21st Century at Springfield in 1996, Advances in Addiction Medicine at Harvard University in 2000, etc.).
In 1999 the library moved to Dr. Kishore's Brookline facility, where it hosted even more innovative programs (the Addiction Law Center with Attorney Heather DeVincent-Cook, and a collaboration with the Harvard English Department to start a Philosophical Recovery Group and a Literature Therapy Group, etc. The NLA transplanted the Women for Recovery meetings and curriculum from Pennsylvania to Massachusetts, spawning an Artists in Recovery group as well as cooking and knitting classes for traumatized young women. This list doesn't even begin to exhaust all the programs conducted by the library.
Alan Balsom, Director of Health and Human Services for Brookline, recognized the value of the library and offered to house it and its many programs. The library was accordingly relocated to the Public Health Building at 11 Pierce Street from December 2002 to 2005 December, where it initiated a Smart Recovery group as well as an AA group. The NLA provided a rigorous Core Curriculum in Addiction Medicine to physicians (a six-to-twelve month effort to present the data distilled from the books on its shelves) and instituted a monthly Continuing Medical Education program.
The library moved to its permanent home in December 2006 in Springfield. Books and administrative offices occupied the first floor, classrooms on the second floor, two apartments for visiting scholars on the third floor, along with a full basement for experimental work (not to mention a barn that the NLA undertook to convert into a church). The library began to acquire collections at this time. The acquisition of books from Dr. David Lewis, Dr. Hugh Fulmer, and Dr. William McAuliffe necessitated expansion of the NLA to include a second site in Fitchburg. The library's growth finally required expansion into a third building on Beacon Street in Brookline.
The Brookline branch of the National Library of Addictions also served as the administrative site for the nascent American College of Addiction Medicine, the Neuroscience Center, and the American College of Correctional Medicine. The NLA partnered with the Massachusetts College of Pharmacy to offer a one-year residency program in Clinical Pharmacology, and allied with the American Board of Addiction Medicine to offer a one-year formal training program (both goals of which were realized, producing trainees coming out of the pipeline).
The Library allied with Harvard Divinity School to educate pastoral trainees concerning addiction guidance for their congregants. Bishop Hogan was just about to bring these students into this NLA program when the state's actions closed both the clinics and the library.
The National Library of Addictions actually occupied three brick-and-mortar buildings in three cities. But if you get your news from the media and Internet blogs, you would only know one thing: this library never existed. It was a delusional fraud cooked up by Dr. Kishore.
So who, really, is trafficking in delusional frauds? Is it Dr. Kishore, or those crafting media stories and blog posts about him?
Martin G. Selbrede is Chalcedon’s resident scholar and Editor of Faith for All of Life and the Chalcedon Report.