The Massachusetts Medical-Industrial Complex vs. A New Pioneering Revolution in Addiction Medicine
By Martin G. Selbrede
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 re-approach 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. TheMassachusetts 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 sobrietyneeds 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.
Massachusetts Derails Revolution In Addiction Medicine While Drug Abuse Soars By Martin G. Selbrede
Part 2 in a series about the pioneering work of Dr. Punyamurtula Kishore
In the previous article, we examined the revolution in addiction medicine set in motion by Dr. Punyamurtula Kishore and how the state of Massachusetts wielded its prosecuting power against him and his clinics, which have consequently been shut down.
Naturally, some readers were tempted to do Internet research on Dr. Kishore and found they weren’t prepared to read the countless evils attributed to him by the media campaign to vilify him. Over the course of this second article and those that follow, we will dissect, point by point, all the nonsense currently parading as journalistic fact in the media. The reality distortion field fostered by both state and media defies explanation.
But there are some medical truths about Dr. Kishore’s holistic treatment program, known as the Massachusetts Model, that have been as completely erased as his Wikipedia page was the day he was indicted. The kind of “memory war” being waged against Dr. Kishore has been nearly total in extent. As he regards the GPS ankle bracelet that restricts his movements, speaking of the relentless pressures being applied against him by the Attorney General, he ably captures his personal situation with a single word: Kafkaesque.
As noted in the first article, there are competing treatment models for drug addiction. There are what Dr. Kishore calls “the fragmented approaches,” such as those that substitute methadone or Suboxone® for the abused substance. Under these scenarios, the addict has replaced one dealer (his pusher) for another (the state) with dependency on narcotics as active as before (albeit in a regulated program using prescribed narcotics). With such “replacement therapies” being a billion-dollar business, it isn’t surprising to see media concern over the growth of “methadone mills.” The state does one better than the local pusher: it pays for bus and taxi vouchers to get the addicts to the methadone.
Now pay close attention: when we read about the “consensus” of medical experts concerning how addiction treatments should operate, or how frequently drug tests should be administered, the hidden assumption is that the experts are right. Confidence in the consensus of enforced orthodoxy rules the roost.
But recall the point made in the first article in this series: the proper yardstick to measure success in addiction medicine is sobriety. Modern medicine isn’t interested in objective measurement because it would expose the disaster that current paradigms inflict on people.
Strong words, yes. So it is now time to back them up with clinical evidence: evidence that blows the orthodox approach out of the water, and puts modern medicine on trial.
The Elephant in the Room
If you assumed that Dr. Kishore’s approach was better merely because it was holistic, or non-narcotic, or integrated, but otherwise came pretty close to conventional addiction medicine in terms of measured results, you’re in for a shock.
In the previous article, we pointed out that under conventional treatment programs, only 20% of those entering those programs are still sober after the first month. What’s the situation after an entire year of conventional treatment? Out of 100 people entering such conventional programs, how many are sober after one year? Between 2% and 5% are sober after one year. And that higher 5% number is a “soft” statistic, because a significant number of those individuals comprising that 5% are self-reporting their sobriety: their sobriety isn’t the result of an objective test. So, the conventional medicine of the “experts” cited in the government documents of Massachusetts gets no more than 5 out of every 100 entering addicts through to sobriety after a full year of treatment. This is the world that these “experts” know, the miserable reality that they accept as inevitable.
Compare those dismal statistics to Dr. Kishore’s Massachusetts Model. For every 100 addicts entering his program, 37 are sober at the end of one year. That 37% success rate is a “hard” statistic as it is established with actual testing (blood, urine, saliva, sweat, hair), not self-reporting. There is objective proof for that 37% success rate. The best the standard treatments achieve is returning 5 out of every 100 addicts back to society. Dr. Kishore delivers 37 out of 100 back to society: his approach is 7 to 18 times more effective in treating addiction.
So, what do the medical experts say about those 32 people out of every 100 entering their conventional treatment programs that they fail to help over the course of a year, people that Dr. Kishore does deliver from the life-destroying power of substance abuse?
The methadone and Suboxone® clinics, which are 5% effective in treating addiction over the span of a year, are still running strong, yet drug addiction is skyrocketing in New England. In a January 16, 2014 news conference, Massachusetts Senate President Therese Murray said her state didn’t just have the worst heroin addiction problem in New England, it had the worst in the entire country. But those clinics that were achieving a staggering 37% effectiveness in treating addiction were dismantled by a mindless government juggernaut, while the Christian doctor who pioneered these unprecedented successes was reduced to poverty and the loss of his reputation in a hail of media lies.
It isn’t as if Dr. Kishore’s method is comparable to the status quo, or only marginally better than what current medicine characterizes as “best practices.” Dr. Kishore’s treatment regimen is far more effective than conventional medicine in real world results.
So who, then, is the real expert in addiction medicine?
Perhaps the only way to compete against such an enormous performance edge, with a growing base of clinics radiating into the worst areas of Massachusetts (such as Weymouth and Springfield, where Dr. Kishore had opened two clinics), was simply to take Dr. Kishore out of the picture. And this is exactly what the state of Massachusetts did in September, 2011. The takedown was done very shrewdly, by throwing a tarp over the elephant in the room and then measuring Dr. Kishore’s program by conventional canons of treatment.
In other words, the valedictorian was judged by delinquents and dropouts, with the media mindlessly spreading misinformation dutifully supplied by the latter. We’ll provide some examples of this toward the end of this article. But first, it behooves us to take a deeper look into Dr. Kishore’s hands-on approach to better understand the truth behind the legal attacks.
The Second Month of Treatment
In the earlier article, we spent considerable time discussing the complex array of events that occur during the first four weeks of treatment, the phases that Dr. Kishore has analyzed and separately treated with such success. With conventional treatment programs, only 20% are still sober after one month. That Dr. Kishore has 37% still sober aftertwelve months is due in large measure to what he achieves in the first month of treatment under the Massachusetts Program. But the path to sobriety entails further complexities in the life of addicts, who need to make it all the way through a full year without any serious relapse.
As noted earlier, sobriety brings problems back to the surface, and so Dr. Kishore’s unprecedented success in the first month of treatment can draw out detractors protecting the status quo: “You sobered him up and look, he killed himself. He should have had methadone. Dr. Kishore is a killer!” But such claims ring false because nobody died while under Dr. Kishore’s care. For someone practicing addiction medicine, a perfect record in respect to patient mortality while under one’s care is extraordinary. (Of course, the closing of his clinics put his former patients at risk, but this was the consequence of state aggression, not of Dr. Kishore’s program.)
The second month of treatment involves considerable myth-busting: a deep dive into the drug ecosystem to bust up existing mythologies. Some of this mythology is in the addict’s mind. What Dr. Kishore calls “stinking thinking” is exemplified by such notions as “I took drugs because my mom boozed it up.”
It’s a delicate process to disabuse the addict of his or her myths during the second month of treatment. It is necessary to reset the patient’s logic-the patient’s thinking systems-regarding boyfriends, girlfriends, peers, employers, family, and life situations.
The second month is not an arms-length, remote treatment program, but requires face-to-face, in-person redirection of the patient. It is all about the resetting of boundaries.
Conventional treatments barely scratch the surface of what’s required to get patients through the second month. This is why, for every patient who begins the second month of today’s status quo treatment programs, only 50% make it through to the third month. Under Dr. Kishore’s approach, fully 90% of those entering the second month make it through.
“I set the bar quite high,” Dr. Kishore says, “in contrast to the establishment message to medical professionals, which amounts to this: it’s okay to be a bottom-feeder. These lowered expectations drive the copouts and rationalizations foisted on the people of Massachusetts.”
The Third Month and Beyond
During the third month, the addict’s physiology returns to its pre-narcotic state, introducing new problems. Let’s consider two representative examples.
Women on drugs don’t menstruate, because opiates suppress the menses. But after a period of sobriety, menstruation resumes, often in the form of polymenorrhea (e.g., weekly menstrual periods). Some women get painful premenstrual migraines as well. Their body is still recovering, responding to renewed sobriety in ways that involve primary care, the main emphasis of a good physician.
Men who had Crohn’s Disease (a leaky gut) prior to addiction were delighted to discover that their narcotics habit fixed this problem. No more ruined underwear: those abused drugs were a plus! But sobriety brings back the original problem. This falls under the umbrella of primary care: the physician is actually able to do M.D. work once again. It is the primary care doctor who is best situated to reset these natural physiological baselines for the patient.
Beyond the physiological dimension is the social interaction aspect: the patients need fellowship, they need someone to confide in. The physician might find himself in the position of an English butler as he deals with the patient’s needs. But whether physiological or interpersonal, the treating doctor must be vigilant about his patients. “Otherwise,” says Dr. Kishore, “you will miss important cues that tell you the recovery is in jeopardy and in danger of being derailed.”
In months four through six, the patients will still exhibit the same cues and triggers as before. The addict will “celebrate” his or her sobriety with a drink. They need to keep their eyes on the summit to keep climbing. They can’t look down to contemplate how far they’ve come, because they’ll simply let go of their grip on the rock that’s holding them up.
Says Dr. Kishore, “Addiction turns a person into a one-trick pony: get drugs, use drugs, sleep, go to job, repeat. We need to break this pattern, and prevent new vicious cycles from taking its place.” Too many addicts gravitate to unhealthy substitute activities: extreme sports become the norm for males, sexual promiscuity for females. Extreme sports lead to injury, which leads to pain, which leads back to pain medications and their abuse. Psychological pain resulting from promiscuity traces a similar path back into abuse. In both cases, it isn’t sufficiently appreciated that addicts generally feel pain more intensely than non-addicts. The treating physician needs to be on top of this.
Dr. Kishore summarizes the situation very simply. “My peers don’t want to invest this much time in an addict’s life, but the reality is that an addict is surrounded by things that will pull them down. Nobody recognizes this. You have to be there with them to know this, and to treat them accordingly.”
The purpose of getting the addict through an entire year is to insure that all seasonal triggers have been covered. Aside from those that form a natural part of his or her life (holidays, birthdays, and other calendar mileposts and celebrations that can trigger drinking and drugging) are external factors, including seasonal affective disorder. “Sobriety Maintenance is of necessity a one-year process. The addict needs unbroken sobriety for all four seasons,” says Dr. Kishore. “Nobody is doing this but us. We do this because we do care.”
Behind that web of personal and social elements is the hard science of measuring sobriety. Dr. Kishore’s philosophy in this respect is foundational to his success. “Drug testing is the golden rule. An addict’s denial systems are robust. Drug tests cut through them.” It is on this point that Dr. Kishore and establishment medicine disagree, and this disagreement constitutes a major element in the case against Dr. Kishore. We will see how the testimony of those “experts” with the 5% success rate was leveraged to destroy the doctor with the 37% success rate. In the mean time, heroin addiction is skyrocketing and overdose deaths are worsening in the Commonwealth of Massachusetts. The statist fiddle plays as Rome burns.
Slips, Relapses, and Testing Frequency
One charge that appears repeatedly in media indictments of Dr. Kishore is that he was conducting urine tests too frequently, doing so to make a fast buck at the state’s expense. The state auditor published the results of a three-year study that cites the consensus of “medical experts” to argue for reduced testing frequencies. Testing more frequently than the norm is indicative of waste and/or fraud.
Before we address the question of testing frequency, note precisely how the state measures that frequency. The state asks, “How many tests per patient were conducted over time?” The state then conducts statistical analysis based on the answer to this question. And if all therapies had identical track records, perhaps that approach could be justified. If Dr. Kishore’s results matched those of the methadone therapists, one could argue that his testing frequency might be excessive.
So, imagine that Dr. Kishore tests twice as often as a conventional addiction program does, just for the sake of argument (we’ll see later this isn’t the case, but is useful to illustrate the point). If we measure strictly by who’s in those programs, Dr. Kishore would then be testing twice as often as the conventional programs do.
But what if we asked the question in a more intelligent way? “What is the ratio of the total number of tests performed to the number of patients still sober after one year?” Measured by actual success rather than raw participation, the conventional programs are testing urine nearly four times more often than Dr. Kishore does. They are the ones squandering state money on testing in support of a 95% failure rate. The conventional yardsticks not only misrepresent reality, they actually endanger the very people they were allegedly designed to help.
Further, isn’t the doctor achieving a 37% success rate better able to articulate the proper approach to urine testing than the ones achieving a 5% or lower success rate? How many lives are lost because the tail is allowed to wag the dog, and mediocrity to trump excellence?
The medical profession merely pools its ignorance as it rallies around the standard therapies that yield financial benefits to doctors, while the state further compounds that pooled ignorance by comparing notes with other states. This drives costs down by using the lowest common denominator as the anchor of reference.
The Massachusetts auditors approvingly cited the policies of other Medicaid bureaucracies, such as that of Georgia, which limits members to 25 tests per year. The report cites other money-saving approaches: “New York will only pay for two tests per week, Vermont for eight tests per month, and New Jersey for two tests per month.” All such arbitrary limits were proposed by pre-selected experts who (1) have nowhere near Dr. Kishore’s years of experience with these populations and modalities and (2) can only dream of achieving treatment success on the scale achieved by Dr. Kishore’s low-tech approach to addiction medicine. (A Harvard faculty member saw through the Boston Globe‘s chosen “authority” on testing frequency: “That MGH clinician is an expert with adolescents, not chronic alcoholics and drug addicts who inhabit the sober homes. His clinical judgment is irrelevant.”)
In the Massachusetts Model developed by Dr. Kishore, testing is proportioned to the patient’s specific situation and accounts for the distinction between a relapse and a slip. A slip back into substance abuse is not yet a full relapse, and if caught early enough can be treated without having the patient restarting week-one detox all over again (with all progress lost). Urine testing is designed to catch slips before they become relapses, taking into account the cues and triggers distributed throughout the seven days of a given addict’s week.
In other words, all such testing is deliberately designed and patient-specific, not indiscriminate. This is most obvious at the two testing extremes. At the Dios Houses (God Houses or Prayer Houses) in Springfield, Dr. Kishore prescribes only weekly testing because such groups provide superior oversight, speaking to the spiritual needs of the patient in a structured way. At the other extreme, a 16-year-old emancipated minor may require as many as five or six tests a week when most vulnerable to resuming substance abuse. If a sober house program is weak, the testing needs to be boosted, intrusive though it is.
But for most of Dr. Kishore’s patients, three tests per week secured the best results in terms of relapse prevention. He estimates the mean number of tests per week across all his patients to be around 2.2. How strange, though, that he is the one who has to justify his testing frequency. One would think that the programs that fail to give 32 out of 100 people their lives back, as Dr. Kishore’s program does (37% versus their 5%), should be the ones to justify their testing strategies.
When testing isn’t frequent enough, the addict’s arrival at the treatment center can be an exercise in futility. “You have a wasted visit if we’re talking to an addled brain,” notes Dr. Kishore. A lapse in testing can amount to a missed opportunity, with the treating doctor receiving the most disheartening of phone calls: “Your patient is here at the hospital with a lesion on his arm” (denoting the infected site where he injected drugs again).
It would be dangerously naïve to think that the government thinks all this through to ask itself, “Why mess with success?” Political expedience does not involve helping the citizens of Massachusetts recover from their state’s heroin crisis. The state spends $11 billion a year on Medicaid and $4 billion on public health: 46% of its $32 billion budget, much of it directed to some sort of addiction care. Despite being an unsustainable drain on the people of Massachusetts, the call to throw even more money at the problem without changing tactics is being raised again. Why? Because the state’s best hope for addressing its drug addiction crisis was arrested at his home at 10:45 PM on September 20, 2011. The events that led up to Dr. Kishore’s jailing that night provide a disturbing glimpse into the pit of Massachusetts governance.
The State’s Tangled Web
Attorney Paul Cirel, of law firm Collora LLP, briefly served as Dr. Kishore’s lawyer in 2006 during a Blue Cross audit of his clinics. Cirel and Kishore parted company in December 2007. “We didn’t see eye to eye,” says Dr. Kishore.
On May 2, 2009, Dr. Kishore was in New Orleans at a ceremony conducted by the American Board of Addiction Medicine (ABAM). As he was preparing to go onstage to receive his ABAM certification, he received a phone call from Paul Cirel. “I’m going on stage right now, I’ll call you back after the ceremony,” Dr. Kishore told Cirel.
After receiving his certification, Dr. Kishore returned Cirel’s call. This is what Cirel told him: “I’m going to call the Board and tell them you’re resigning as a doctor. You won’t need your license anymore.” This was the first obvious shot across the bow, which Dr. Kishore rebuffed.
Then, on December 22, 2009, the Attorney General Office’s Brian Robinson conducted a sting operation against Dr. Kishore at a sober house called Safe Haven run by a lawyer no longer allowed to practice law. This sober home consisted of four or five buildings rife with sex and drugs, a place where eight to ten people had previously died. Not knowing it was a setup, Dr. Kishore went to the meeting with his Chief of Nursing and other key team members.
The entire conversation was videotaped through one-way mirrors. Neither Dr. Kishore nor his associates said or did anything illegal. The sting failed of its purpose, which was evidently to catch Dr. Kishore bribing Safe Haven with a $10 kickback per drug test.
As a result of this stunt, the government wasted the time of a busy physician and his staff in its efforts to try and entrap him. The request to Dr. Kishore to have him come down to help the Safe Haven sober home was a government lie. It was a sting operation and nothing more. Apparently stung by the failure of its own ruse, the Attorney General’s office began to escalate the attacks on Dr. Kishore.
One of the apparent sticking points was a curious one. “My labs are integrated into my practices,” Dr. Kishore pointed out. Although he only tested his own patients, this was seen as a threat to commercial testing labs (one of which launched a frivolous civil suit against Dr. Kishore’s clinics in March 2011 over alleged monopolistic practices). Legislation to outlaw integrated labs was introduced in 2013 (to protect commercial labs from God-knows-what).
By 2010, Dr. Kishore was at the top of his game. All audits of his clinics turned out well (a 1999 MassPro audit revealed deficiencies corrected without incident, a 2007 MassPro audit found no deficiencies whatsoever, and the clinics passed a five-year prospective audit by a government Medicare auditor in December 2009). Dr. Kishore’s pioneering achievement, the Massachusetts Model, was working well and generating excitement about the future of addiction medicine.
That’s when the gorilla showed up.
The ensuing grand jury indictments were premised on co-employment and co-location of services with sober houses, arrangements that the state reclassified as bribery and kickback schemes despite the presence of legally valid signed contracts. The irony, as noted by a Harvard faculty member, is that Dr. Kishore’s business structure matched the authoritative description of valid co-location and co-employment models published in October 2010 by the National Association of Community Health Centers.
“We paid rent for space, we paid employees, and we followed the Safe Harbor Rules. My company, PMAI, had two lawyers on staff, one specifically to help insure compliance with the law in all we did.
Predictably, a state system as complicated as this is bound to break.”
With $1.7 million in cash reserves to run his clinics (which had a $9.9 million annual payroll due to the labor-intensive nature of getting a 37% sobriety rate at the one-year mark), Dr. Kishore acquired a new attorney. On October 8, 2010, PMAI’s HR lawyer introduced Dr. Kishore to attorney Frank Libby (of Libby & Hoopes, which reportedly had close ties to the state’s Attorney General). Libby proposed the following settlement: “I want you to plead guilty pre-indictment. We’ll monitor you for five years and then you can resume practice. That’s how it works in Massachusetts.” The state wouldn’t accept a settlement that didn’t destroy all 52 of Dr. Kishore’s practices, so the good doctor fired Libby.
Massachusetts expected accused doctors and clinics to plea-bargain and settle, but Dr. Kishore refused to be the victim of so blatant a shakedown. It appears that Massachusetts law has never put a case like this all the way through the judicial process: Dr. Kishore might well be the first to run the full length of the gauntlet.
Dr. Kishore then met attorney Don Stern, thinking that he might be the salvation of his medical practices. Stern’s focus was corporate and criminal law rather than health care law. Stern met with Attorney General Martha Coakley and returned with an ultimatum: Dr. Kishore needed to give up all his on-site labs to survive. “We don’t want you to run labs” was Coakley’s position as reported through Stern (a man for whom Dr. Kishore has high regard).
Testing labs can be the “cash cow” of a practice, but Dr. Kishore’s clinics rolled their laboratory revenues back into the practice, investing in expansion to help more patients with his superior addiction treatment program. Unlike Dr. Kishore’s on-site labs, however, commercial labs keep their money: it’s all profit. Perhaps it’s no surprise then that powerful interests own the commercial testing labs in Massachusetts.
Come July 2011, Dr. Kishore had to cut down the size of his practice: 32% of his income had been frozen by the state without notice, causing the remaining cash to dwindle quickly given the labor-intensive nature of the Massachusetts Model for addiction treatment. His practice shrank down to about a half dozen centers just to survive. As a result, the treatment benefits to addicts relying on the closed centers were abruptly cut off.
The Arrest of Punyamurtula Kishore, M.D., M.P.H., F.A.S.A.M.
Assistant Attorney General Nancy Maroney set up a meeting with Dr. Kishore and his attorneys for September 27, 2011, but he was arrested without warning a week earlier, at 10:45 PM on September 20. No meeting with the attorneys occurred as scheduled, apparently because Maroney’s proposed meeting was a fabrication. Dr. Kishore spent the night at the Medford Police Barracks. He was taken to court on September 21, appearing before an array of cameras and members of the media, 40 strong, which had come from as far away as Brazil, India, and China to gape at the spectacle being heralded by the Attorney General.
The media was told that the prisoner was planning to escape to India with embezzled Medicaid cash (Coakley later asserting that “he stole $20 million.”) The alleged “escape to India” was the pretext for the surprise arrest. Dr. Kishore, like many other dedicated physicians, firmly believed in the concept of doctors without borders and never bothered to change his Indian passport. Although he hadn’t been to India since 1986-a quarter of a century earlier-the fact of his Indian passport was used as a legal cause against him. The fact that his wife and children are American citizens somehow got lost in the media circus.
The massive amount of media present from so many countries suggests that this was a well-planned hit against Dr. Kishore, one calculated to boost Ms. Coakley’s stature as a prosecutor ferreting out fraud. By making the case a high profile one, the state was now committed and refused to admit error or retract its claws: this man Kishore was both a crook and a menace, as established with confident zeal by media fiat. Appearing in court exhausted, haggard, and unshaven, he looked like the perp he supposedly was. Ecce homo. He was transferred to Middlesex Jail prior to the bail hearing the next day (at which the judge refused to permit cameras) and from there he was moved to a downstairs cell at the Middlesex courthouse in Woburn around 2 PM on September 22, 2011.
The Attorney General did not want Dr. Kishore released on bail, but his attorneys negotiated an arrangement requiring that he surrender his passport and wear the GPS ankle bracelet.
Following Dr. Kishore’s release, there was a shift in the media war as voices raised in defense of Dr. Kishore (and in opposition to the brutal tactics and specious reasoning of the state) grew into a chorus of disaffection with Ms. Coakley. This apparently motivated her to hold another press conference on September 30 to defend her actions. Despite Dr. Kishore having been released with a GPS ankle bracelet, she had him rearrested on October 6, landing him back in jail once again. The second arrest was arranged by filing new charges, increasing the bail amount, and arguing before a judge that the prior bail arrangement should be vacated and the man incarcerated without warning. The judge initially agreed and issued the warrant.
In court the next day, the prosecution reasserted that Dr. Kishore should never be released from confinement. The defense countered that the previous judge declared the original bail conditions to be adequate. That one glimmer of sanity managed to break through this Orwellian process and Dr. Kishore was released. Why arrest him a second time and insist he not be released? Had he remained in custody, you would have never known the story of Dr. Kishore and his breakthrough in addiction medicine, nor about the resulting breakdown in governmental ethics that crushed his work underfoot. He would have been left in the memory hole in which the state was determined to keep him.
Despite having two arrests on record against Dr. Kishore, the Attorney General still had very little to show for all this sound and fury signifying nothing. She was maintaining a media tempest in a legal teapot. The thin grounds for indictment were looking ever thinner.
The paucity of evidence led to the infamous email heist known as EmailGate, with the state prosecutors looking for dirt they simply didn’t have by raiding Dr. Kishore’s gmail accounts, including his discussions with his attorneys (or not, if you still have faith in the “anti-taint” procedures designed by the fox guarding the chicken coop). Nonetheless, the media strategy against Dr. Kishore was straightforward and consistent: people believe that if there’s smoke, there’s fire, so the press releases and media coverage painted a sky full of smoke.
As a result of these crippling actions by the state, Dr. Kishore’s remaining clinics survived only two weeks past his September 21 arrest. By his second arrest, they fell apart completely because unpaid yet dedicated employees had no choice but to leave and seek work elsewhere.
He Was Numbered With the Transgressors
For media purposes, Dr. Kishore’s case was bundled with other cases, cases marked by significant numbers of collaborators and reports of collusion. Other companies hauled before the state’s tribunals had groups of individuals indicted (since conspiracy necessarily involves co-conspirators). However, Dr. Kishore stood alone: he was the only person at PMAI who was indicted. In the state’s eyes, Dr. Kishore masterminded the complex “kickback scheme” entirely on his own, without any assistance or co-conspirators from his own firm. To the state, he was a one-man wrecking crew. How remarkable that the man who developed the most successful addiction treatment program to date, a program requiring such an extraordinary amount of hands-on time on his part, had time left over for not only for his wife and children but also to mastermind a multi-million dollar fraud all on his own. In this instance the sheep were scattered, but the shepherd alone had been struck.
But Dr. Kishore’s story rarely appears alone: it is always conflated with the stories of other perpetrators, and to this day is resurrected (automatically and mindlessly) when stories “associated” with his case appear in the media, thus keeping his name before the public in continual connection with others.
While averse to playing the race card, Dr. Kishore cannot help but wonder why mention of his case (in sidebar posts on media websites for “related stories,” etc.) almost always appear when stories about aliens accused of illegal actions are run. This media practice has the net effect of inciting xenophobia against him, continually pushing these older negative stories about him ever higher in Internet search engine rankings. From Dr. Kishore’s perspective, this is no accident: the destruction of his reputation bears all the marks of an orchestrated campaign.
An illegal alien, scheduled to be deported, was caught in a raid and given a GPS ankle bracelet just like Dr. Kishore wears. The Boston Globe successfully applied media pressure to lobby to get her ankle bracelet removed. Dr. Kishore, who is here legally, still has his ankle bracelet on two-and-a-half years later. Is this a double standard, or is it simply too important to maintain around-the-clock vilification of Dr. Kishore to be even-handed?
Look up a local media article about accused Boston Marathon bombing suspect Tsarnaev: there’s Dr. Kishore’s story on the same web page. Look up an article about Salvatore DiMasi: there’s Dr. Kishore’s story in the side bar. He’s always being associated with shady characters. Just as with the Attorney General’s press conference, he continues to be numbered with the transgressors by the local media.
Such content aggregation by the media creates what amounts to manufactured news. The interest in Dr. Kishore’s story doesn’t originate with the public. It is forced upon the public in an Orwellian fashion. Dr. Kishore doesn’t see these as merely neutral insertions: he believes he’s being continually sullied by these media processes.
Since May 2013, Berger & Montague’s website out of Pennsylvania has had the top-ranking story on Google about Dr. Kishore, replete with authoritative-looking hyperlinks. Whether it is or isn’t, the page looks like a staged blog. The hyperlinks provided aren’t relevant to Dr. Kishore’s case, pointing to a different case altogether. This creates a false association, a false impression built on a foundation of dislocated authority.
Solomon wrote that the way of transgressors is hard (Prov. 13:15). Did the state treat Dr. Kishore in terms of this proverb after his arrest? It certainly seems so, and if so, then coercive pressure was being applied in ways that border on the abuse of power. A very conservative driver (as I know from personal experience with him), he nonetheless received eight traffic tickets in just six months after his release on GPS. Garner too many tickets and you lose your driver’s license, further restricting your ability to travel. Dr. Kishore successfully fought all but one of the tickets (what a colossal waste of time for a pioneer working to save the lives of addicts to appear in traffic court every two weeks). Was Dr. Kishore an easy target for ticketing because of his GPS ankle bracelet, with police like moths being drawn to the flame? Nobody truly knows. That this particular smoke might come from an underlying fire is more plausible than the Attorney General’s trial-by-media program.
The Commonwealth of Massachusetts is like a fisherman who’s caught a dolphin in his net as well as actual fish: “Dolphin, what dolphin? That thing has fins and swims. It’s no dolphin. I only catch fish in my nets!” And what better way to prove that the alleged dolphin is really a fish than by pasting scales on it, cutting gills into its cheeks, and twisting its flukes by ninety degrees? This process is what the next (and final) section of this second article will begin to examine.
Did Dr. Kishore Provide “Improper Care” To His Patients?
Dr. Kishore requested a speedy trial, meaning it should have begun six months after arraignment on March 21, 2012. State foot-dragging pushed the trial to June 4, then to September 2012, then to January 2013, then April 2013, then October 2013, and now his trial is scheduled for April-May 2014.
These denials of Dr. Kishore’s right to a speedy trial were spearheaded by the state. Why? If the state has hard evidence against the accused, why keep pushing the trial off into the future? What does time buy prosecutors with a solid case on their hands? Nothing. But if you’ve cobbled together a case that’s built on spurious grounds and still need to find a smoking gun, you’re likely to keep postponing in the hope that more data-mining might yield something that will stick against the defendant you’ve been mistreating.
Perhaps one reason for these delays is the possibility that the prosecution wants to be able to demonize Dr. Kishore with a particularly stinging label: a doctor who was reprimanded by the state board of medicine for providing improper care to his patients. If the reprimand could be made to stick, then Dr. Kishore could be made out to be an incompetent doctor, destroying his credibility (and that of his treatment program for addiction). By going after a malpracticing physician, the Attorney General can argue that the prosecution of Dr. Kishore isn’t malicious but justifiable. After all, the medical board went after this man! Such a fact could potentially swing a decision in the prosecution’s favor during the main trial, as it would bear on Dr. Kishore’s character and professional ethics. In other words, he’s no dolphin, he’s a fish who rightfully belongs in our net: we caught the right guy.
On September 19, 2012, the board of medicine told Dr. Kishore, “We want to revoke your license.” His attorney at the hearing pointed out that the board cannot revoke on a “first offense” (if there even was an offense). What was the alleged offense, anyway? Why is he being reprimanded? The board told Dr. Kishore why: “You arranged to send four drunk women to the hospital” (see Appendix A below for details). Dr. Kishore was fined and sanctioned but kept his license-and he appealed the board’s action (thus suspending the fine until the appeal could be heard).
The Massachusetts Psychiatric Society (MPS) caught wind of this case. Representing 1,700 psychiatrists, the MPS attempted to intervene in Dr. Kishore’s case, arguing in effect that they regularly do the very thing Dr. Kishore did, and if the board was going to sanction such life-saving policies, then the 1,700 psychiatrists wanted a voice in that hearing since a negative outcome for Dr. Kishore could impact their practices and their patients in a disastrous way.
In March 2013, the board granted the intervention request of the psychiatrists, meaning Dr. Kishore effectively had 1,700 other M.D.s standing in legal and clinical solidarity with him on this matter. This was a wonderful ray of light in a very dark time.
That ray was snuffed out on October 7, 2013, when the Attorney General’s office successfully convinced Judge Frieger to reverse the original decision. Dr. Kishore stood all alone once again, no longer with the collective weight of 1,700 psychiatrists standing by him: their voices were driven out of the courtroom. The psychiatrists were limited to submitting a friend of the court brief-their thunderous shout was throttled back to a polite whisper.
Dr. Kishore’s appeal (now without the MPS standing next to him to argue the same issue against the board) is scheduled for March 2014. In a just world, he would win the appeal. In a moral world, the board wouldn’t have silenced the voice of 1,700 psychiatrists (who hold both Ph.D. and M.D. degrees). But Dr. Kishore might lose the appeal and be reprimanded, or worse. The fact that revocation was demanded despite this being Dr. Kishore’s first appearance before the board suggests that this is precisely the result the state desires.
Should the board exonerate Dr. Kishore for protecting those four lives in 2006, another strategy to revoke his license has emerged. On December 9, 2013, John Costello of the board’s complaint committee wrote Dr. Kishore stating that Costello would recommend revocation of Kishore’s license at the committee’s February 5, 2014 meeting. Why? Because Dr. Kishore lost two medical records-two records out of a total of a quarter million records.
One of those two records was lost to vandalism at the Brookline clinic after Dr. Kishore’s sudden jailing. The other record, locked inside the Framingham clinic by the landlord, will be recovered shortly. Costello’s letter, devoid of justice and common sense, exudes the kind of raw bureaucratic power that prompted this article’s legal reviewer to tell me, “In their system, there is no defense against such charges.” When I mentioned that doctors in New Orleans who lost medical records destroyed by Hurricane Katrina were off the hook thanks to a new state initiative, I was told “Yes, but those doctors weren’t the target of an attorney general.”
Perhaps the prospect of having a discredited physician entering the courtroom motivated the postponement of the main “kickback” trial until after these board actions took place. Should Dr. Kishore succeed in appealing the reprimand and fending off the complaint over vandalism beyond his control, the prosecution case is no worse off. But if either the reprimand or complaint sticks, the prosecution could leverage their target’s resulting loss of credibility: he was a fish all along, never a dolphin. The public sees doctors who lose their licenses as quacks.
Dr. Kishore arrived in the United States in 1977 with only eight dollars in his pocket. If the board of medicine and the Attorney General have their way, he will soon be worse off now than when he arrived.
Appendix A: Autopsy of a Medical Board Reprimand
The reprimand against Dr. Kishore involves the fact that he arranged to have four women transported to the hospital. The power to transport is contained in state law: MGL Part I, Title XVII, Chapter 123, Section 12(a) governs transportation of an incapacitated patient who may also be a danger to himself or others. This gives the M.D. permission to transport the patient (e.g., to a hospital) and to call an ambulance. You need the so-called “pink paper” to do this. If you transport without a pink paper, you are violating the patient’s civil rights. Only three groups-doctors, police, and social workers-have the authority to order a pink paper.
On August 4, 2006, four women came in drunk to a sober house, violating the curfew. Dr. Kishore had them transported to the emergency room, but once there they refused to be tested. “The board reprimanded me for transporting the patients without seeing them, but I did see them that very morning, and I based my decision on the dangerous change in them from earlier in the day. I was 30 miles away from the sober house when they contacted me, and I simply couldn’t waste precious time driving out to re-examine the women without a chaperone present. The law states that there is no need to examine the patient if there’s enough data on the table to justify transportation. If a patient calls up drunk, perhaps threatening to cut their wrists or to sleep and not wake up, you force the issue by calling the police.”
The Massachusetts Psychiatric Society, representing 1,700 psychiatrists, noted in their paperwork filed with the board that their members have referred 40,000 patients per year using pink papers without seeing the patient. The MPS holds that psychiatrists need this power, and that they need to exert it from afar before a situation escalates.
The psychiatrists of Massachusetts each send an average of two dozen people a year to hospitals using pink papers without first seeing them. Dr. Kishore did this with only four people in his entire career, and he had actually seen those four the day they were transported. Yet who was threatened with the revocation of his medical license?
Dr. Kishore summed up his position in this way: “Relapse is a danger to the patient’s life. The behavior of the four women had dangerously altered since I had seen them in the morning. I was in a damned if I do/damned if I don’t situation. When you face something like that as a doctor, you have no choice but to apply the Hippocratic Oath: Do no harm. They were my patients, and I wasn’t about to hear that one of them fell asleep in bed with a lit cigarette and died in the resulting fire, or chose to overdose that night and die in her sleep.”
Dr. Kishore sued the Commonwealth of Massachusetts to appeal the board’s reprimand. The case will be heard before his main trial begins. In the meantime, all you will read in the media is that Dr. Kishore was fined and reprimanded for providing “improper care” to his patients. Should he prevail in his appeal, you will not likely hear of it: the stories of the “improper care” reprimand will not be revised, and the truth of his exoneration will not likely be published. If he fails in his appeal (now that the 1,700 psychiatrists of Massachusetts have been shocked to learn that they have no stake nor voice in the outcome of this obviously pertinent case), that would likely become a heavily-touted story leading into Dr. Kishore’s main trial because that news would be politically useful.
The Pioneer Who Cut New Paths in Addiction Medicine before Being Cut Down
By Martin G. Selbrede
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.
Article from Chalcedon.edu