This is the sixth in an ongoing series of articles about Dr. Punyamurtula S. Kishore, the Christian doctor who innovated the Massachusetts Model of addiction treatment. The previous five articles painstakingly 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 pitiful few who haven’t relapsed after that time 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 an embarrassingly 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 sobriety maintenance program).
Massachusetts buried this medical miracle in its midst by incarcerating Dr. Kishore in September 2011 and withholding Medicaid payments to his fifty-two treatment centers, causing their complete collapse. The sordid details of the state’s continuing atrocities against Dr. Kishore form a nerve cord winding through the previous five articles. To repeat the preceding documentation, even in condensed form, would consume half of the present article. If you’ve not followed this series from the outset, review the earlier articles before diving into this latest article. Without the factual background the earlier articles provide, you may continue to fall prey to ongoing manipulation (by omission and commission) by the state and its media gatekeepers.
Note also that on October 10, 2014 we attempted to formally contact Massachusetts’s Attorney General, Martha Coakley, through her Director of Communications, Brad Puffer, but have not received a response to our set of questions as of press time. Should a response be forthcoming, we will make an effort to incorporate any meaningful new data into the record.
Recalculating the True Impact of the Kishore Takedown
We live in a time when voters are willing to overlook a remarkable amount of baggage weighing down a political candidate if those unflattering details can be mitigated or favorably spun. And so it goes with the top law enforcement official of a state: attorney generals are supposed to be tough on crime. If a few innocents go down along with the guilty, such collateral damage is an unintended side effect of the AG’s zeal and diligence. Such “friendly fire,” say the apologists, is a rare occurrence, but because such instances are newsworthy they’re quickly “blown out of proportion.” An occasional dolphin can still get caught in the fisherman’s net, after all, but the target was always fish, never dolphins.
When a dolphin (such as Dr. Kishore) is caught in the net intended for fish (true Medicaid fraudsters), the state is loath to admit error and, as pointed out in an earlier article, will simply cut gills into the dolphin’s cheeks and twist its flukes ninety-degrees and exult, “See, it was a fish after all.” If this program fails after several years of dragging out a case, the electorate has short memories. Since the Attorney General of Massachusetts who spearheaded the actions against Dr. Kishore, Martha Coakley, is currently running for governor of her state, perhaps voters should be aware of the true legacy this candidate has carved into the lives of the people she would rule over. To do this, we must frame the situation using truth, not political expedience, as our yardstick of choice.
If voters in the state were inclined to assess the net damage inflicted by the actions of their attorney general, they would think of it in terms of a single doctor being wrongly suspected of fraud who might eventually be exonerated. As documented in an earlier article in this series, a major exoneration this year that overturned a case strikingly parallel to Dr. Kishore’s case (the Franey Medical Labs case) went unreported by The Boston Globe. Out of voters’ sight, out of voters’ minds.
Not surprisingly, then, voters tend to think of Dorothy Rabinowitz’s No Crueler Tyrannies, if they think of it at all, as water under the bridge … Pulitzer Prize-winning water, maybe, but water under the bridge in its reporting of prosecutorial excess. The common DNA supposedly shared by Dr. Kishore’s case and the earlier cases is that the rights of individuals were at stake in these controversial prosecutions. Even if a case was prosecuted in error (or out of malice or to build a political future) the victim count remained tiny while far more “real bad guys” were put away. When the outcome is framed this way, pliable voters will put up with collateral damage, will accept some friendly fire, at the hands of their attorney general. They might even reward this individual with the governorship of their state.
The Deadly Truth
The engine driving this political mythology is a dangerously false concept. It is the deadly idea that the takedown of Dr. Kishore and his PMAI treatment centers only created a brief treatment outage from which the state was able to spring back and meet any resulting shortfalls, thus absorbing the impact of those clinic closings. Any problems caused by the forced closings were explicitly blamed on Dr. Kishore while the existing treatment systems (those with a success rate less than 10% of Dr. Kishore’s success rates) were praised for taking up the slack.
Assume Martha Coakley never prosecuted Dr. Kishore in September 2011, then wind the clock forward twelve months to September 2012 and count how many of his patients have not relapsed into full-fledged drug addiction based on his vetted clinical record. Now repeat this scenario but add the prosecution and clinic closings back to the timeline. What has changed? Thousands of people who would have been sober (at Dr. Kishore’s 50% to 60% success rate) are now buried under conventional treatment’s abysmal 2% to 5% success rate. For every thousand that would have enjoyed a full year of sobriety by September 2012, nine hundred have, in real life, completely relapsed, because the second scenario is the actual situation inflicted upon Massachusetts.
After the clinic closings, those few patients of Dr. Kishore’s that found doctors willing to prescribe non-narcotic VIVITROL® fared somewhat better than those placed in conventional (methadone- and Suboxone®-based) treatment programs, but VIVITROL® forms only one part of Dr. Kishore’s comprehensive treatment model. Prescribing VIVITROL® in isolation yields a success rate under one-half that achieved by the full Massachusetts Model of sobriety maintenance (see the first, second, and fifth articles in this series).
Consequently, had Dr. Kishore been a run-of-the-mill addiction specialist prescribing methadone or Suboxone® rather than being a recognized trailblazer innovating vastly superior addiction treatment regimens without the use of addictive drugs, one could argue that he was the one person being adversely affected by this prosecution. But there is a mathematical certainty no political spin doctor can alter: you cannot take thousands of people out of a program with a 50% to 60% success rate and transfer them to a program with a 2% to 5% success rate and not generate enormous human loss on a massive scale. Build ten thousand more methadone clinics in Massachusetts if you want, but those numbers will not change. They are etched into stone.
The closing of Dr. Kishore’s clinics consigned thousands of his patients to inevitable relapse into the mire of addiction and hopelessness. These re-broken lives need to be laid at the foot of the attorney general whose actions obliterated the superior treatment program these people were in. Also complicit in this preventable carnage is the media, which continues to cast a blind eye upon the true extent of the collateral damage inflicted by the grinding power of state machinery. To crush the full story of what Dr. Kishore achieved is tantamount to crushing all these now-ruined lives underfoot in callous disregard of human value.
The Deadlier Truth
All extrapolation is hazardous as it forces us to extend trends with incomplete knowledge. There is comparative safety in extrapolating between a point in the past (September 2011) to the present (October 2014), especially since the last three years have shown no improvement in the success rates of traditional addiction treatment. This should not be a surprise since these treatment programs have not changed one iota. They perform as they did decades earlier: very, very badly. (See the first article in this series on how this fact is cleverly hidden.)
On the other hand, Dr. Kishore’s methods were continually evolving and improving. He had improved his sobriety results from 37% in 1994 to between 50% and 60% by 2011, and was working tirelessly to achieve nothing less than 100% or die trying. We will never know what his program would have achieved given three years of additional research with an even larger clientele (250,000 total patients when his clinics were shuttered). But it is safe to assume that the Massachusetts Model results wouldn’t degrade because the protocols delivering his miraculously high success rates year after year were proven with clinical rigor over countless patient histories. (These histories are a major reason the state’s efforts to vilify and demonize Dr. Kishore have gained no traction. Each life he rebuilt created inexorable ripple effects and did so ten times more often than his horse-and-buggy-bound colleagues could achieve.)
We’ve already established the massive damage to Dr. Kishore’s patients inflicted by Martha Coakley’s actions against Dr. Kishore. This would be bad enough, but the state of Massachusetts is in the midst of an officially acknowledged public health crisis (see articles four and five in this series) with respect to drug addiction. So now it is time to ask a more uncomfortable question.
Assume Martha Coakley had never moved against Dr. Kishore. At the rate that Dr. Kishore’s treatment centers were expanding three years ago, how many additional patients would have gone through his clinics in that span of time?
These are touchy questions. It is state policy to promote methadone and Suboxone® treatments while pretending the ensuing 2% to 5% success rate is a medical wonder. Dr. Kishore’s clinics were growing based on merit, not state advocacy, empowering the mothers of Massachusetts rather than narcotic companies (guess which of these two is more likely to make campaign donations).
As mentioned in earlier articles, other states saw more value in Dr. Kishore’s work than did Massachusetts, the namesake of his Massachusetts Model. Dr. Kishore was a convenient bogey on a prosecutorial radar screen. As documented in the first two articles, his medical successes actually worked against him. He was what Malcolm Gladwell calls an outlier. The system within which he worked does not tolerate outliers. It cynically used out-of-context aspects of his achievements to destroy him and to continue to crush him even further to this very day.
Had the Massachusetts Model been allowed to refine itself further and sustain its existing exponential growth rather than being shut down at its height of expansion in 2011, many thousands more would have passed through Dr. Kishore’s practices and more than half of them would have been delivered from addiction. Instead of passing through a growing nexus of clinics treating at a 50% to 60% success rate, the state’s drug addicts were mindlessly shoved through conventional clinics with a 2% to 5% success rate. The best solution to addiction was sidelined at the worst possible time (while it was spreading to meet the need) and inferior methods were heralded as the answer. The media repeated these state lies about treatment effectiveness and papered over the state’s complicity in creating the existing crisis by its actions. The media protected the powerful while letting the multitudes rot.
Let there be no mistake. There would be no public health crisis in Massachusetts today, no trail of ruined lives extending to the horizon and worsening, had Martha Coakley not set out to destroy Dr. Kishore and his work. Massachusetts today would be the model for other states to follow (as it actually was up until Coakley’s attack upon Dr. Kishore). This state owes its current crisis to its attorney general. For reasons that remain inexplicable, it seems the voters intend to reward Ms. Coakley for her callous disregard of the commonwealth she took an oath to protect by giving her the governorship. If so, their mandate to her must be something on the order of “let this ruin be under thy hand” (Isaiah 3:6).
Martha Coakley Versus Ebola
To put the human cost into perspective, let’s reduce Dr. Kishore’s case to a parable about the Ebola virus. In this mythical parable, Dr. Kishore develops ZMapp serum to treat Ebola. After some initial positive results, the attorney general takes the doctor in custody and destroys all the serum. The media never mentions the serum so the electorate knows nothing about it. Ebola outbreaks start popping up all over the state. The attorney general runs for governor, wins the election, and is in charge of handling the Ebola crisis. While there is no ZMapp serum to be seen, there is posturing and rhetoric aplenty.
Too extreme an analogy, you protest? You’d be right. Drug addiction in Massachusetts is doing far more harm, right now, than the Ebola virus could do to its citizens. The parable above paints too rosy a picture of the actual situation.
Drug addiction is deadlier than Ebola in terms of the toll in human lives. Those lives it doesn’t destroy quantitatively (by killing the addict) it destroys qualitatively. For a culture to dismantle its own best hope against this scourge is an irrational, suicidal act. The actions of Martha Coakley were either done in full knowledge of Dr. Kishore’s achievements, or they were done in ignorance of his work. Neither scenario speaks well of someone charged with administering justice.
What wisdom is shown in destroying fifty-two treatment centers across the state of Massachusetts that are routinely documenting a drug addiction success rate more than ten times higher than any competing clinics? By what calculus can such brutal actions be even remotely justified? The only beneficiaries of such actions are the pharmaceutical firms that manufacture methadone and Suboxone®, who continue to find a vigorous advocate in Michael Botticelli, a Massachusetts export to the federal drug czar position (see the fifth article in this series). It appears that when Dr. Kishore was arrested, the unnamed source that told the media that Kishore wasn’t licensed by the state to practice addiction medicine was Mr. Botticelli. By putting this perversion of the truth into play to discredit the embattled defendant, Botticelli raised the specter of coordinated state action in the takedown of Dr. Kishore’s clinics.
The truth is much more simple. As such, it should be stated with simplicity.
The Tree of Hate
I’ve taken the liberty of borrowing this phrase, The Tree of Hate, to lay out the logical conclusion of the above analysis. By this phrase I do not mean Martha Coakley’s repeated denunciations of Dr. Kishore (and quiet back-pedaling when overstatements came to light). Yes, such vitriol invited her listeners to hate Dr. Kishore on first one ground and then another, bidding them to see him as the thieving foreigner she was going to exact punishment upon (see the first article in this series for details). But this phenomenon, ghastly as it is in respect to the individual affected by it (Dr. Kishore), is not the tree of hate. It is only a daisy of hate. It is no tree. And voters at the mercy of the media will grant an attorney general an occasional miss if there are many more hits than misses in prosecuting individuals. A daisy of hate here or there is just collateral damage, or so the electorate tends to reason.
No, Martha Coakley’s tree of hate has nothing to do with Dr. Kishore personally. The tree of hate arose because Martha Coakley put her career on one pan of the scale and the lives of many tens of thousands of Massachusetts citizens affected by the plague of drug addiction on the other pan, and then forced the first pan down with all her weight. By this act of hatred, she declared her political career more important than all the lives affected by the destruction of Dr. Kishore’s clinics. When put in the balance, she made clear that the lives of all those Massachusetts citizens meant nothing to her and should rightly be swept away, out of consideration, out of sight, out of mind.
Whether or not Martha Coakley received political or financial returns by protecting conventional addiction treatment centers, Big Pharma, independent testing laboratories, and others who benefited by the takedown of Dr. Kishore’s clinics isn’t material here. Even if she did, these would represent the things she loves and worked toward setting in order in her state by her actions. If not, fine. Voters expect politicians to have constituencies other than the electorate. Voters tolerate this.
No, the tree of hate needs to be the focus. How much must you hate your fellow Massachusetts citizens that you would act with calculation to consign them to the misery of a public health crisis that you have personally pushed into high gear? How much must you hate these people that you would deny these citizens of your state, by the thousands, to get the best treatment that any state in the country was providing at the time?
And how much must you hate them that, after flushing all the serum down the toilet, you try to wheedle them into voting for you?
If the citizens of Massachusetts will just open their eyes, they’ll be able to see Martha Coakley’s tree of hate. You really can’t miss it. The tree is so tall its crown pierces the heavens. That tree can be seen reflected in the eyes of your fellow citizens, neighbors, and countless family members affected directly and indirectly by the growing scourge of drug addiction ravaging your commonwealth. That scourge grows in your state because your attorney general chose to throw gas on that fire while imprisoning the best fireman in the whole country.
Then said all the trees unto the bramble, Come thou, and reign over us. And the bramble said unto the trees, If in truth ye anoint me king over you, then come and put your trust in my shadow: and if not, let fire come out of the bramble, and devour the cedars of Lebanon. (Judges 9:14–15)
The First Five Articles in This Series:
Malcolm Gladwell, Outliers (New York, NY: Little, Brown & Company, 2008).
A new trend is developing which uses software algorithms to detect “outliers” and exact punishment on them (on the principle that statistical anomalies invariably are smoking guns signifying Medicaid or Medicare fraud). See http://www.21ct.com/products/t... for an example of just such a system. As mentioned in the text, such nets are intended to catch fish (true frauds) but cannot be tuned to avoid catching dolphins (innocent innovators pushing the envelope).
I’m referring to the book by American historian Dr. Phillip Wayne Powell of the University of California Santa Barbara. I had the pleasure of personally working with Dr. Powell in the early 1980s in the preparation of a new edition of his book The Tree of Hate: Propaganda and Prejudices Affecting Relations with the Hispanic World.