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The Only Thing Worse Than Letting Addicted Docs Practice is Banning Them...

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The AP is reporting on controversy in California over the way treatment for addicted doctors is handled by the state medical board.

California recently scrapped its system for anonymously treating addicted doctors without informing patients of their physicians' condition -- following outrage over botched surgery by an addicted plastic surgeon. But its new cure for the problem may be worse than the disease.

For one, what the AP doesn't mention is that treatment for addicted doctors is one of the shining successes in the addiction world: virtually all treatment (even programs known to contain elements that are ineffective or harmful) produces impressive outcomes.

Some attribute this to the fact that impaired physicians are closely monitored to ensure abstinence. However, my reading of the data is that because having meaningful work is a strong correlate of recovery, physicians -- due to the nature of their occupation itself -- have a good prognosis.

As one formerly addicted doc told the AP, "Working actually helps them get better."

Failing to allow doctors to anonymously seek treatment and removing their licenses as soon as addiction is confirmed -- as California plans to do-- is not likely to allow patients better knowledge of whether their docs are addicts or not. It will simply make doctors go to greater lengths to hide their problems and avoid ever seeking treatment. And, of course, likely doom the doctors who are cut from the profession to the low odds of recovery that come with unemployment.

These types of effects are seen consistently when punitive attempts to stop addiction are tried. Most notoriously, laws to imprison women who use drugs while pregnant led to reduced use of prenatal care -- which actually can be more harmful to babies than their mothers' drug use itself.

Medicine itself owes a large debt to addicted doctors: the classic example is William Stewart Halsted, known as the "father of American surgery." Amongst other achievements, he introduced science-based training into American medicine, developed the mastectomy for breast cancer, pioneered control of bleeding in surgery and instituted the use of gloves. After an early period of cocaine addiction, he switched to morphine, which he took for his entire career.

Under California's new rules, he would have been cut from medicine before he made many of his most important contributions. [Cross-posted from Scientific American's 60 Second Science]

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