The true story of the man who touched medicine's third rail
My flight into Rhode Island arrived after midnight, but the man I was meeting was unable to pick me up at the airport. He waited for me on the Massachusetts side of the border, intending to take me to the conference site from there. For most people, driving across a state line entails nothing of significance. But most people don't have to wear a court-ordered GPS ankle bracelet to restrict their movements.
Most people don't have enemies who broadcast assertions that they are registered sex offenders, either. These assertions were no different from others alleging that the man I'm meeting wasn't licensed to practice addiction medicine in Massachusetts--claims that should have evaporated when he produced the actual license. Disgusted that I was obligated to verify what I already knew to be true, I searched for his name on the national and state databases for registered sex offenders. Nothing. But nobody else encountering those vicious posts will ever bother to fact-check them, on the dubious principle that if you read such a matter-of-fact charge on the Internet, it must be a matter of fact. The man I was meeting had been efficiently demonized as a monster.
At the same time, the Attorney General of Massachusetts had this doctor in her crosshairs, having shut down all of his dozens of clinics across the state and freezing more than $4 million of his assets that he would have used to pay his employees and vendors and defend himself in court. The state-orchestrated campaign against this doctor defies belief, with countless media tricks used to smear him. He is charged with Medicaid fraud, using an alleged "kickback" scheme so "intricate" and "complicated" that no prosecutor can satisfactorily explain precisely what law he violated.
With their case vaporizing on them, Massachusetts simply turned up the heat on the doctor. This smacked of the old debater's trick: if your case is weak, pound the podium and shout. In court on December 11, 2013, the prosecution telegraphed its intention to hand down forty-four additional indictments to supplement the original counts. This would not only apply pressure to plea-bargain or settle, it would distract from the prosecution's Constitution-violating sifting of the defendant's Google email account-including 680 emails between him and his defense attorneys. On the face of it, the prosecution seems to be looking to justify the trampling of the accused's rights after-the-fact. Demons and monsters, after all, have no rights. Therefore, prosecutors can go fishing now and bother about search warrants later (as they confidently affirmed).
But there is one crucial element about this case that, once grasped, casts the entire prosecution and the round-the-clock vilification campaign in a completely different light. It has been deliberately obscured and falsified, but it is vitally important to understand. For you would be mistaken in thinking that the defendant is simply caught in a legal maelstrom and nothing more, a story perhaps suitable for a Readers Digest column entitled "That's Outrageous." But this legal battle is itself the tip of a bigger iceberg. Something much bigger is at stake, something striking at the very core of the medical profession itself.
It is for this reason that I flew to Massachusetts as an independent investigator to meet the man calmly standing at the violent intersection of very powerful constituencies, all of which have a stake in controlling the narrative and steering the outcome. You will need to connect the dots for yourself and draw your own conclusions. The fact that some of those dots literally represent human blood can make this an emotionally charged journey for many. There can be no escaping this reality. But this story is charged with hope: it was born in hope, and realized its promises before the death blows fell. The light of its promise remains.
This is the story of Dr. Punyamurtula Kishore, arguably the twenty-first century's greatest pioneer in the treatment of substance addiction, whose Massachusetts Model program far out-performed the existing treatment paradigms at vastly lower costs-until his clinics and his reputation were destroyed in the fall of 2011.
This is part one of a series of articles. As you read this first article, you may be tempted to ask yourself, cui bono, that is, who benefits from these attacks upon Dr. Kishore? If so, you wouldn't be alone, for it was with supreme irony that the day I left Massachusetts (Nov. 17, 2013), the New York Times ran a long front-page story by Deborah Sontag called "Addiction Treatment with a Dark Side." A large photograph of a Bible page appears on the newspaper's front page with the first three verses of Genesis apparently marked in yellow highlighter. But the yellow on the page wasn't highlighter ink: it was the drug buprenorphine being smuggled into prison using the Bible. This drug (a main ingredient in Suboxone) vies with methadone in treating substance addiction: these two treatments dominate the field and do so quite profitably.
But when someone like Dr. Kishore, bristling with formidable credentials and a strong track record working with 250,000 addicts, breaks ranks with these enforced orthodoxies, any success he enjoys will pose a problem. Because his cheaper and more effective low-tech alternative sends a perceived pox on both your houses message to the two treatments championed by the medical-industrial complex, it was perhaps inevitable that something had to give.
In this case, the question of whose approach is superior was not resolved by comparing clinical data or statistics (upon which Dr. Kishore's record is based).
Rather, this question was resolved using force.
What Happened to the Other Eighty Percent?
Nature abhors a vacuum, but those who prepare statistics on the success rate of addiction programs appear to be very much attached to a large sinkhole corresponding to the first four weeks of treatment. Such success rate graphs omit that first month and fix the success rate at the beginning of the second month at ~20%. In other words, treatment for 80% of those addicted failed within the first four weeks, but the graph obscures this circumstance. Rather than focus on that demoralizing first month (which openly defies attempts to apply the term success rate to it), conventional charts omit it. Even then, the remaining 20% of patients continues to slide into recidivism from week five forward. It would appear that the four out of five patients who never even made it onto the success rate graph are considered as acceptable collateral damage. The system expects such losses in the first month and regards them as both normal and inevitable.
Part of the reason for this attitude is the fact that addiction medicine actually involves multiple disciplines (twenty different fields), but has been reduced to a dangerously simplified set of concerns. Further, M.D.s are only given a few course hours in addiction medicine while regulatory agencies have lowered the requirements for M.D.s to prescribe treatments like Suboxone. Once in possession of a hammer, the physician might easily see every problem as a nail. The two big hammers, methadone and Suboxone, now form the axis around which orthodox addiction treatment is expected to orbit.
In the interest of full disclosure, I add here that a pain specialist prescribed methadone for my wife (who, doctors later speculated, lacked the liver enzyme necessary to metabolize it). It built up slowly in her system over eight days, at which point she died in her sleep in 2005 at the age of 39. Despite this personal connection to the issues framed here, my primary interest is to shed light on better solutions to the addiction problem, as opposed to pain control.
It should be noted that Dr. Kishore fully grants that genetically-predisposed addicts might well need replacement therapy, thereby justifying their use of methadone. The problem arises when methadone is hailed as a universal panacea rather than being suited only for a small minority of addicts (~6%). Such expansive claims mean the treatment will gain a foothold so tenacious it can never be dislodged from center stage.
Dr. Kishore challenged the notion that those massive relapse statistics in the first month were inevitable. He studied the dynamics of the addict's situation during those first four weeks of treatment and realized that this crucial period fell into four distinct phases of approximately one-week duration each. If one could successfully bridge the patient across this four-week period, one could mount a frontal attack on those miserable statistics. This would not only fill that embarrassing hole, but would reposition the starting point of the conventional graph much higher than the dismal 20% survival rate we see today.
The resulting program that Dr. Kishore has been developing since 1989, which he calls the Massachusetts Model, inexorably put him on the radar as his success grew. In 2004 the Boston Celtics honored him as "The Doctor of Addiction Medicine," and he received their "Hero Among Us" award. Four years later, Harvard studied his program with keen interest. By 2011, when the Attorney General shut his practice down, he had 52 centers across the state. Perhaps not surprisingly, his work was more highly regarded in the surrounding states than in the state that bears the program's name.
Would Dr. Kishore have been shut down had he toed the orthodox line and prescribed methadone and Suboxone according to prevailing expectations? His results would have matched those of the orthodox practitioners had he done so, but because this was not a morally acceptable option for him, we will never know the answer.
We will revisit the legal attacks against Dr. Kishore later, but it is worthwhile to survey his powerful findings in relation to that first month of treatment, the month for which conventional wisdom defends an 80% relapse rate as reasonable. These findings provide the real-life context for the battle still raging in the courts of Massachusetts, which subsequent articles in this series will explore.
As you read what follows, you will come to understand how sprawling the multi-disciplinary nature of addiction medicine actually is. The twenty foundational disciplines that underlie addiction medicine are these: primary care, behavioral sciences, psychology, psychiatry, sociology, social anthropology, criminology, criminal justice, law, forensic sciences, public health, social work, management sciences, psychopharmacology, clinical pharmacology, toxicology, occupational medicine, genetics, government policy, and behavioral neurology.
In light of the above, we can see the fallacy inherent in the common question, Who should treat addiction? Counselors? M.D.'s? Psychiatrists? Social workers? Peer groups? No one of these has the whole picture or the entire toolkit, and the partial solutions they offer often rest on faulty premises. Effective addiction treatment is inherently a multi-disciplinary endeavor, and piecemeal approaches (such as the government generally pursues at great expense) yield poor results. Attempts to quantify success are often short-circuited by a refusal to develop a measurement standard for it. This omission prevails because too many philosophies of treatment would be exposed as inadequate were they to be actually measured, not only clinically but in terms of the personal cost of addiction to actual human beings.
A piecemeal approach attempts to reduce a complex problem to one or two elements and ignore the rest. In humanist worldviews, reality is fragmented and it is therefore legitimate to shun a holistic approach in favor of working on a fragment. The large sums of money expended on such piecemeal approaches are usually the only proof offered to cover political considerations that the effort is worthwhile.
The blame for recidivism is placed upon the addicts themselves rather than the inadequacy of the fragmented approach-itself the stepdaughter of a pessimistic philosophy of treatment stemming from a humanistic worldview premised on the fragmentation of all disciplines into discrete elements without mutual cross-pollination.
So, let us ask the question again and then answer it: Who should treat addiction? Counselors? M.D.'s? Psychiatrists? Social workers? Peer groups? No one of these has the full skill set, and neither does Dr. Kishore. But rather than pursue a piecemeal approach, Dr. Kishore hired people who had the expertise to fill in all the holes so that all the bases were covered. This involved considerable coordination, not unlike conducting an orchestra and keeping the realignment process in sync so that it doesn't derail. Dr. Kishore answers "All Of The Above" in response to the question, who should treat addiction? In that light, let's see how he successfully implemented a holistic, systemic solution to addiction.
The First Week
Why is the traditional success rate so low at the one-month mark? What was happening in those first four weeks of treatment that led to 80%+ relapse into addiction?
Post-Acute Withdrawal Syndrome (PAWS) is the primary cause of relapse during the first four weeks, leading to that grim statistic. Dr. Kishore directed his focus onto PAWS using comfort medicines (not addictive new narcotics) to break the relapse cycle.
One must not confuse the popular notion of withdrawal symptoms (nausea, vomiting, diarrhea, anxiety) with the symptoms stemming from PAWS. PAWS involves repeating cycles of a suite of symptoms that include sweating, generalized achiness, malaise, loss of appetite, restless leg syndrome, fatigue, sleeplessness, simply "not feeling right," "feeling icky," "not feeling normal," etc. This estate is not merely the heavily-advertised "new normal" because the addict simply doesn't see it that way despite physician assurances that it will pass. Modern medicine often treats the standard withdrawal symptoms but not the PAWS symptoms, and it is the latter symptoms that often drive the addict to relapse during the first week.
Accordingly, during the first week of treatment Dr. Kishore saw his patients every day. He was essentially conducting real-time field epidemiology as he treated these men and women, building a framework for an empirically intuited treatment model. As a result, he was doing the legwork, the heavy lifting, for subsequent researchers to build upon.
The first seven to ten days involves a biological cycle in which the body is healing from the drug, producing things it needs to achieve homeostasis, healing itself, all in the effort to "cool down" from the addicting drug. During this first week, Dr. Kishore treats not only the well-known withdrawal symptoms but also the symptoms of PAWS. For example, how does one treat sweating (hyperhidrosis)? Dr. Kishore's research found that doctors had been treating movie stars and actors who were sweating under hot Klieg lights by using Robinul Forte (glycopyrrolate). Administration of this non-narcotic compound prevented the addict from breaking out into sweating cycles: a simple solution, but one apparently never applied to drug addiction before.
Dr. Kishore minimized the impact of the restless leg syndrome component of PAWS by prescribing Requip (ropinirole). Mood swings and anxiety were reduced by prescribing non-addictive Clonidine (not to be confused with addictive Klonopin®). Using this strategy, he was able to break the back of the post-acute withdrawal symptoms that were pulling the patient back into addiction. He was able to silence the body's call to the addict to return to the addictive substance.
These were important, critical steps that had to be taken, but they were not adequate because addiction involves more than the biological systems of the patient. Relapse was still possible, and the driving impetus toward relapse after the body had been physically healed fell into three phases, generally corresponding to the second, third, and fourth weeks of treatment.
The Second Week
In the second week of treatment, it's not the body calling to the addict but his mind. A process of rationalization kicks in, whereby the patient, knowing he or she had been controlled by the substance, now wishes to reciprocate, to exercise control over the substance, to prove that it doesn't control him. Dr. Kishore likens this to "riding the tiger," on the mistaken principle that the only safe place around a tiger is sitting on its back. The patients exhibited so-called "magical thinking" (the premise of all magic is the control of things: oneself, others, natural phenomena) usually taking the form of various idiosyncratic rituals.
One example: an MBA writing notches on a bottle to prove he had "only drank so much that day," evidences obsessive-compulsive thinking (planning and scheming) to demonstrate alleged control over the addiction. Another example: someone testing himself with a small piece of a pill and bragging to the doctor that he was able to "control" his impulses. Addicts also adopt physical rituals that would do a superstitious professional athlete proud in how they reapproach the addicting substance. Alcoholics do this by going from conventional beers to O'Doul's, which has a 2% alcoholic content, but the principle is the same and the danger to the addict is the same: they make promises to themselves that they can't keep.
The addict needs group support, the "been there, done that" group that remains the best antidote for breaking the rationalization cycle, the false sense of control the addict wants to affirm over the addictive substance through incremental indulgence (a slippery slope if there ever was one). This calls to mind the first lesson inculcated by an Alcoholics Anonymous support group: the addicts must humble themselves and accept and fully own their powerlessness to avoid getting pulled back into the abyss. Frequency of support varies with the need, but Dr. Kishore makes sure there's availability for all such support seven days a week (in stark contrast to current paradigms and government programs).
The Third Week
By the third week of treatment, it's no longer the body that calls to the addict, or the mind, but the social network that shifts into high gear to reclaim the addict as their own, to place him back into the constellation of users within the drug ecosystem. The ecosystem even extends to habits and associated environmental cues ("The sun is coming in this morning through the blinds; I need to go see my dealer now"). All such cues (former triggers) need to be extinguished, so that all elements of the ecosystem are neutralized so far as their conditioning power is concerned. Past reflexes to environmental cues need to be extinguished, and the addict desensitized to their formerly determinative impact upon him.
Beyond environmental cues in the ecosystem, individual humans make up the social network. The drug user's social network is a self-serving family, and it perceives the addict's attempt to leave the network as betrayal. The network reacts, applying pressure to recapture the addict. If these efforts fail, the dealer essentially excommunicates the addict: "He's a traitor. Don't talk to him." The network's reaction can be violent, even brutal, involving threats to the addict as well as to the addict's friends and family to escalate its resolve to protect its own interests.
One powerful solution that can be effective at this stage is the safe house, which provides a haven from the impact of the social network's imposition of pressure upon the addict. This often involves separating the addict from his cell phone so that the network cannot communicate its rage to the addict, which could influence the addict to reconsider the benefits of relapsing so he can rejoin his former peer group. You can't be guilt tripped if you can't hear the accusations. A safe house is temporary, transient-a place far away from the social network. The addict needs to be separated from the animosity his former social network directs at him.
One serious danger, at this point, is that a vindictive dealer, suspicious of the addict's recommitment to the group, will hand him a "monster bag," an overdose designed to kill the unreliable member of the group. The dealer doesn't trust him/her and so will protect the group (the enterprise) at the addict's expense. The ecosystem is very possessive of its membership.
The reality is that many drugs are bartered for services (not necessarily paid for in cash), which tightens the screws that hold the drug ecosystem together at the personal level. One drug dealer (a policeman by day) threatened to turn an addict over to the law with a false report that the addict had molested his child while babysitting the boy. Dr. Kishore, mindful that addiction involves a huge cascade of issues far beyond the biological dimension, relocated the addict in a new job out of state to completely sever the link to the dealer. The dealer's intent to debase the character of the addict by giving him a police record (and making him unemployable) was defeated by Dr. Kishore's quick action. As he notes, this isn't rocket science: just do the right thing. But the social networks know how to keep addicts within their grip by destroying the possibility of a meaningful life outside the network. We'll see later the significance that having a job has for people in these situations.
For opiate and alcohol addictions, Dr. Kishore prescribes Naltrexone (an opiate antagonist) at this point in the third week, which can be repeated once a month thereafter to assist in stopping the cravings dead in their tracks.
The Fourth Week
By pulling addicts out of the drug ecosystem, their former social construct implodes on them. The crucial need then is to backfill the loss of community they feel, now that their former circle has ostracized them.
This means that even if the addict survives the first three weeks without relapse, he's not out of the woods. The implications of breaking with the social network behind the drug ecosystem now come home to roost. It's not the body calling them, or the mind, or the social group, it's the spirit. Having been excommunicated, they become lonely and experience an identity crisis. (No surprise that Dr. Kishore's Massachusetts Model includes a class called "Who Am I?" to deal with this crisis.)
Moreover, at this stage the addicts see themselves as they really are, not through the rose-colored glasses the addictive substance provided that blinded them to their own nature. All their blemishes are clearly seen. Is life worth living, given who I am or what I've become? The spirit calls them, saying "Join me in hell" or "Join me in heaven." The appeal of suicide looms large as a convenient answer to the crisis of identity, the loneliness, the self-awareness, and the hopelessness that can follow on their heels.
That death-wish can be motivated by the grim prospects the now-sober addict can all too clearly see: a mountain of problems (e.g., crippling college debts that look impossible to repay, etc.). Sobriety is painful and is even perceived as a curse, making an escape from reality look attractive. The easiest response looks to be suicide. For example, a prostitute on drugs can easily dissociate herself by thinking, "it's not my body, it's not happening to me." But once sober, she confronts the fact that those things did happen to her, and post-traumatic stress syndrome enters the picture whereas it was absent before. The drug covered up a deeper problem, and the absence of the drug brings that underlying problem back to life. What the patient needs is a new identity: the old identity will drag her down and must be jettisoned.
Life must have meaning, and the addict becomes aware that his life now lacks meaning. Dr. Kishore's approach attempts to address this vacuum. The power of having an actual job cannot be overestimated, because meaningful work produces a new sense of identity. When meaning enters the addict's life, his day becomes organized around that meaning. The Massachusetts Model puts the addict on a consistent schedule, and many become ambassadors for the National Library of Addictions, being paid on an honorarium basis for educating doctors by participating in "grand rounds" (medical lectures that target doctors), being part of group interventions for addicts still in their second week, etc. Those not becoming ambassadors may receive vocational guidance, do community service, etc., depending on the controlling authority in the addict's life at that time.
Incidentally, Dr. Kishore disdains the term "counseling" on the principle that you really cannot counsel an adult. Such counseling is adult babysitting and is inherently ineffective because it uses tactics (redirection, brownie points, reprimands) that adults are impervious to. Moreover, counseling implies that the counselor has the lock on knowledge. This reinforces the harmful notion that the counselor is above the counselee rather than being there to equip the addict to fully step into his role as an adult. If you treat adults as children, you'll get what you subsidize and catch what you're fishing for.
If an effort is not made to help addicts build a desirable new identity at this point, the addicts (assuming they're not disposed toward suicide despite its appearance on their mental horizon) will build a new identity for themselves, identities that may be quite undesirable. An addict might become a pimp, for example. They will switch gears into the one area where they can find employment, having been denied a job on the open market. This is why identity and employment are tied together so closely and why this aspect of the addict's effort to rebuild his or her life must be addressed and not left to chance. The new job, the new identity, must be shaped toward a meaningful, constructive goal for the addict. Otherwise, relapse and/or a socially destructive new identity become the result of the program. The program, in the final analysis, will have failed the addict if this need is not met.
There is a need to create an alternate universe for the addict, a new replacement value system, a new worldview. They looked up to their dealers, now they need to look up to something else. But injecting new values too early doesn't work. If introduced during the rigors of detox, the addict won't listen. If injected too late (after the fourth week), they've already adopted a new identity for themselves (e.g., as a pimp or a loan shark operative). Dr. Kishore has found that the optimal point in time to do value injection is approximately 28 days into the program (the timing varies by individual).
Massachusetts Model vs. Traditional Addiction Treatments
What a different pattern this four-week regimen is from the conventional paradigms. Small wonder: it embraces a multidisciplinary approach and takes into account the complex transitions arising in the body, mind, social construct, and spirit of the addict. This provides the framework for true sobriety maintenance. You will note that methadone and its sister drugs have no part to play in Dr. Kishore's approach. The model sets forth a non-narcotic approach to treating addiction, one that addresses all the crucial variables at play in the addict. Success grows naturally out of this model, on a scale the traditional therapies can only envy.
With traditional therapy, of course, the notion of a success rate is a misnomer. Modern addiction treatment is not sufficiently advanced to justify even using the term success rate. Incomplete research (unverified, unvetted, unduplicated research) is driving the treatment industry. Success rates are therefore defined in self-serving ways designed to place the treatment model being promoted in the best possible light. But those metrics are worse than worthless, because sobriety needs to be the end point of success. You can only measure that if you follow the patients continually, as Dr. Kishore's teams did.
Conventional paradigms are oblivious to the four distinct phases the addict passes through during the first month of treatment. Expensive in-patient rehab programs ($1,000 to $3,000 per day) that last for twenty-eight or thirty days merely postpone the day of reckoning when the addict must pass through those four phases, and these programs provide zero preparation for what's coming. As addicts exit such rehab programs, all their suppressed issues resurface.
Cut loose from treatment and now on their own, these addicts then face so-called "kindling phenomena" (passing by old haunts or encountering powerful triggers and cues) that can lead to relapse. Thousands of dollars are spent on programs that only postpone the inevitable. Industry commitment to business-as-usual fails the addict by failing to deal with the four phases he must pass through after discharge. Because the underlying problems are unresolved, they reappear just as the addict is enjoying a false sense of security inspired by his sense of having "completed" the month-long treatment.
This is where government participation in the conventional therapies becomes most harmful. The state runs massive programs-as if only massive programs will work. In contrast to Dr. Kishore's hands-on approach, government-funded methadone clinics aren't a symbol of the state's concern for addicts but of its indifference toward them. Legislative intrusions by the state deform every aspect of the medical profession, while the most insidious distortions of the doctor-patient relationship are due to the law of unintended consequences.
In respect to doctor-patient relations, for example, the dangerous "Don't Ask, Don't Tell" syndrome predominates today. Doctors avoid asking about a patient's illicit drug use because exposure of the addict's situation can have vocational ramifications (he could be fired from his job). The doctor might have to become an informant and fill out a report that one person is taking medicine prescribed for another. Doctors don't have the time for this. By the same token, an addict won't trust a doctor who will inform on him. So the current system represents an ugly détente in which both doctor and patient wear masks to reinforce the social lies now bonding them together.
Against that standoff, various treatment constituencies work overtime to justify their prescriptions using emotionally laden bromides. "Harm reduction," "No wrong door," "We prevented them from dying"-these self-serving slogans expose underlying philosophies of treatment that are inherently defective. Interestingly, all such rationalizations invoke a principle underlying modern psychoanalysis: the patient should expect the cure either to take a very long time or to be never fully realized (a counsel of despair, masquerading as conventional wisdom). The mainstream treatment philosophies all concede that successful treatment will remain inaccessible, so they lower their sights. You can't hit any higher than you aim.
One key element of all treatment philosophies is the question of WHO is actually solving the addict's problems: is the addict solving his problem himself and simply being equipped to fight the battle, or is the treatment program solving the problem? The power to conquer addiction comes from within the patient, and is an outworking of the patient's multi-faceted worldview.
Dr. Kishore therefore puts the addict, not the treatment program, on the pedestal (which is one reason he refused to name his program after himself). The patient owns his own victory, not the treatment program, laying out a clear runway for long-term life success for the former addict.
The Addiction Ecosystem as a Business Enterprise
The addict is not an isolated victim but merely one cog in a larger piece of machinery (which means addiction treatment must deal holistically with the implications of that ecosystem or it will fail). The addict can be one of the many different cogs in the business enterprise: an end-user, dealer, mule (minor-age carrier), informer (double-agent), lookout/scout, recruiter/marketer, etc.
This network is mutually supporting, creating a quasi-family around the enterprise of providing drugs to the addict. To exit the ecosystem is to betray this quasi-family and usually has dangerous repercussions for the addict and his real friends and family.
The modern government addiction program represents a substitute addiction ecosystem oriented around the administration of drugs such as methadone or Suboxone. The question to be asked is this: is this sanctioned ecosystem any less protective of its enterprise interests than the illicit drug delivery system? If the modern system's goal is to put forward the best possible solutions for the addicts, then why is there such antipathy toward Dr. Kishore's model inside Massachusetts, but not outside? Was his model affecting something inside the state, where it was actually operating, but not affecting those same things outside the state? Could that "something" possibly involve the billions of dollars spent on narcotics-based therapies, or business lost to Dr. Kishore's co-located practices?
That there is an orchestrated hate campaign directed against Dr. Kishore, calculated to discredit him at every possible level (morally, medically, professionally, ethically, legally, personally) is beyond question. I marvel that someone persecuted so mercilessly in the media for so long can remain a soft-spoken Christian gentleman who still is only interested in reaching out to help those trapped by their addictions.
I got only a fleeting personal glimpse into a few of the quarter-million lives he's touched while in Boston, but what I saw was nothing short of deepest heartfelt gratitude for his impact upon them. If Dr. Kishore is the fraud he's alleged to be, he would deserve a Lifetime Achievement Oscar. The Attorney General of Massachusetts must think he's exactly that, since her team blotted out his Sixth Amendment protections without even breaking stride. I would only offer this observation to AG Martha Coakley: Dr. Punyamurtula Kishore is a terrible actor. Truly.
Nonetheless, one must grant that circumstantial evidence is no basis to press formal charges, whether against various industries, government constituencies, addiction medicine practitioners, or any monopolies (real or imagined) against which the cui bono axiom might be leveled. To try this case in the media on my part would be to sink to the same level as those who've already tried the case in the media in Massachusetts. I would therefore suggest that those constituencies protesting that they've had neither a direct nor indirect role in the crippling attacks made upon Dr. Kishore demonstrate their goodwill by helping us find the actual parties responsible for these sustained assaults. It will be my sincere prayer that their search will be more successful than O.J. Simpson's hunt for the real killer, because I fear that for some, their search may well terminate at the mirror.