J. Wesley Boyd, MD, PhD

Check out my AI search query and AI’s response below. Some of the points ChatGPT makes are damning of PHPs, to put it mildly.

AI Query: Why do physician health programs send doctors to residential treatment program when those physicians don’t meet criteria for residential level of placement given the ASAM criteria for what level of care individuals need for a substance use disorder?

Answer: Physician Health Programs (PHPs) frequently refer doctors to residential treatment programs even when they may not meet the traditional American Society of Addiction Medicine (ASAM) criteria for such placements due to a combination of factors:

1. Conservative Approach to Risk Management:
   • PHPs tend to adopt a cautious and conservative approach towards any potential impairment because of the high stakes involved in medical practice. The priority is often to ensure public safety and maintain trust in the medical profession, which can lead to more intensive treatments being recommended.
2. Regulatory and Liability Concerns:
   • PHPs may face regulatory pressures and liability concerns. By recommending comprehensive treatment, they mitigate risks related to future incidents that could arise if a physician relapses or if an underlying issue is more severe than initially determined.
3. Standardized Treatment Protocols:
   • Some PHPs might rely on standardized treatment protocols that emphasize intensive intervention, arguing that comprehensive care reduces the likelihood of recidivism and ensures thorough assessment and treatment.
4. Economic and Institutional Incentives:
   • There may be financial incentives for treatment facilities and PHPs, as residential programs can be profitable. Relationships between PHPs and specific treatment centers might influence the frequency of recommendations for residential treatment.
5. Lack of Tailored Assessments:
   • In some cases, PHPs may not conduct sufficiently individualized assessments, leading to a one-size-fits-all recommendation rather than a personalized plan based on specific medical and psychosocial needs.
6. Perception and Pressure:
   • There is often pressure to maintain high “success” rates for sobriety, and residential treatment is perceived as being more thorough or effective, despite the individual circumstances.
7. Institutional Routine and Culture:
   • Some PHPs operate within a culture that traditionally advocates for residential treatment as a first line of defense, aligning with established practices over personalized criteria evaluation.
8. Misalignment with ASAM Criteria:
   • In some cases, PHPs’ interpretations of the ASAM criteria may vary, leading to discrepancies in care level recommendations. This misalignment might arise from training differences, institutional policies, or varying understandings of the criteria.

While these factors can provide context, it’s crucial for PHPs to strive for assessments and recommendations that align with best practice standards and professional guidelines, ensuring that treatment plans are truly reflective of individual needs and conditions.

Available here.

Despite polygraphs being inadmissible in courts and being considered either full on junk science or just north of that mark, the federation of state physician health programs (FSPHP) and its member state physician health programs (PHPs) are routinely sending physicians to evaluation centers that employ polygraphs. And get this: These centers charge hundreds of dollars for a polygraph, and if a physician doesn’t pass the test, guess what? They can retake it until they eventually pass–as long as they pay for each and every time they took the polygraph.

And as troubling, FSPHP and state PHPs have bidirectional financial relationships–i.e. serious conflicts of interest–with the centers that they’re referring physicians to that are using polygraphs.

Why does this practice copntinue? Because almost no physicians know anything about PHPs or the evaluation/treatment centers that they utilize until they’ve been referred to a PHP. And once that happens and they see what is actually transpiring, if a physician then registers complaints, they’re seen as bellyaching and in denial about their issues, as opposed to perhaps having very real, legitimate complaints.

See my article in Psychology Today here about this bizarre, little known, sad, and unfair state of affairs.

Excellent article on Physician Health Programs here by Frieda Klotz. One problem of PHPs is that they operate with little oversight and almost no ways of meaningfully appealing they’re recommendations. Additionally, they have bidirectional conflicts of interest with the evaluation/treatment centers they utilize. They say these centers specialize in treating physicians which is why they send doctors to all corners of the country, but in reality any good academic department or addition psychiatrist could do what these centers do, only better. And finally, when PHPs say they don’t control licensure but instead that state licensing boards do, that is disingenuous beyond belief, because boards of medicine generally defer every single question of ability to practice to PHPs. Thus, PHPs control licensure decisions for MDs/DOs who have questions of impairment.

https://www.kevinmd.com/2024/06/ai-ethics-in-medical-education-podcast.html

I just published a review of Carl Elliott’s latest book here in the Indian Journal of Medical Ethics. Here are my concluding chapters from the review:

Elliott notes that many whistleblowers start out as idealists. Indeed, that idealism is at the core of what drove them to blow the whistle in the first place. But in the end, whistleblowers can end up with their idealism in tatters: “(Whistleblowers) talk about disillusionment, loneliness, and anger, about their struggles with guilt and shame, about a sense of betrayal and crushed idealism.”

Given this reality, by the end of The Occasional Human Sacrifice, we see that its title refers not just to the research subjects who have died at the hands of researchers, but also to the whistleblowers themselves, who are compelled to proceed even while hurling themselves towards their own demise.

At its heart, The Occasional Human Sacrifice is a testament to the enduring power of the human spirit, a reminder that even in the darkest of times, there are some who refuse to be silenced, and it serves as a clarion call for ethical accountability in an age where the pursuit of scientific advancement, personal aggrandisement, and greed often eclipses the upholding of basic moral principles.

In conclusion, The Occasional Human Sacrifice is a must read for everyone who cares about principles and doing right, but especially for bioethicists, IRB committee members, and others interested in human experimentation gone awry, and the price some pay to shed light on the malfeasance and injustices therein.

Requiring FDA approval for laboratory developed tests would be an overreaction to the Theranos debacle and would ultimately harm patients

See my opinion piece about proposed new oversight and regulation of lab developed tests by the FDA here: https://www.scientificamerican.com/article/an-fda-overreaction-to-theranoss-implosion-would-harm-patients

Federal whistleblower Ellen Gallagher has been decrying the use of solitary confinement on individuals in immigration detention for a decade, but little has changed to date despite her beyond courageous efforts. Today, a report, found here, co-authored by Katherine Peeler at Harvard Medical School, along with others at Harvard Medical School, Harvard Law School, and Physicians for Human Rights, amplifies the message that Ellen Gallagher has brought to attention, namely that US immigration authorities routinely lock thousands of people in solitary confinement and flout international human rights standards in its sprawling network of immigration detention facilities.

Many news outlets, such as this one, have reported the release of Dr. Peeler’s report.

I am beyond ecstatic that the use of solitary confinement in immigration detention is now in the open air and I completely support calls for reform.

Kudos to my friends, colleagues, and sometime co-authors (lucky me!), Katie Peeler and Ellen Gallgaher, for their tireless efforts to expose and report this travesty of justice and all norms of human rights.