Using marijuana 2 times a month cost this doctor his license

Just posted on KevinMD.  The piece is here.  Some state PHPs are advocating a zero tolerance policy for any positive marijuana test and also often have a de facto zero tolerance policy for any positive test for metabolites of alcohol.  That means that even if physicians have never used marijuana or alcohol before going to work and have never even remotely practiced medicine under the influence, physicians might be accused of having a substance use disorder and forced into expensive evaluations and rehab (which often have financial ties to state PHPs) or else run the risk of losing their ability to practice medicine.

Since the national federation of PHPs has not taken action to sever the financial ties between PHPs and their “vetted eval/treatment centers” and eliminate conflicts of interest, all physicians ought to begin to pressure their state medical boards societies and the AMA to effect change.

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Do state physician health programs encourage referrals that violate the Americans with Disabilities Act?

Hot off the presses with co-author Nick Lawson in the International Journal of Law and Psychiatry is this article entitled “Do state physician health programs encourage referrals that violate the Americans with Disabilities Act?”  A PDF of the paper is  available by clicking this link:  Do PHPs Violate the ADA.  And supplemental material for the paper is available by clicking here:  Supplementary Material for ADA PHP Paper 2018

The abstract states:  The websites of many physician health programs provide lists describing signs of impairment or indications to refer physician-employees for evaluation and possible treatment. This study aimed (1) to determine how many of these descriptions likely provide physicians’ employers with sufficient evidence to legally request mental health examinations under the general regulations of the Americans with Disabilities Act (ADA); and (2) to find out who they described. The authors applied US Equal Employment Opportunity Commission guidance documents and sought expert legal advice to evaluate the descriptions for their consistency with the ADA. They used directed content analysis to review and code these descriptions into categories. Very few, if any, of the 571 descriptions appeared to provide sufficient evidence for employers to request an examination under the ADA. About 14%, however, could refer to physicians attempting to defend themselves, assert their ADA rights, or otherwise complain about the hospital; and 27% either described physicians who complain or else had discriminatory effects in one of several different ways. Leaders within the medical field should ensure that their policies and state laws pertaining to physician impairment comply with and incorporate the language of the ADA. They should also reevaluate the functions of these policies, laws, and physician health programs, and the implications for patient safety, physician wellness, suicide, and other important issues.

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Mass Murder in the US

We are the only country where these mass killings happen regularly. Even though some say “How can we prevent this?” the answer is quite clear and has worked in every other country in the world. No way the men who wrote the Second Amendment would stand for this horror. And why on Earth would anyone sanctify the Constitution (which was meant to be amended!) if anyone thought otherwise?


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How mass incarceration harms U.S. health, in 5 charts

Co-author Emily Nagisa Keehn and I just published this piece about the extensive health toll that incarceration exacts.  The AP just picked it up!

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Mental Health Matters–Thinking about Stigma, Parity, and the Obstacles to Obtaining Needed Mental Health Care

Pat Lawrence interviews J. Wesley Boyd., M.D., Ph.D., a psychiatrist at Harvard Medical School. They discuss the crisis in mental health care, focusing on difficulty in getting insurance coverage, substance abuse issues, and advances in treatment.  The interview can be found here.


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Our Youth Deserve Better: We Fail Our Youth When They are Most at Risk for Drug and Mental Health Problems.

I co-authored this piece with Sarah Samuelson for Psychology Today.  In the piece we write that transition-age youth (age 18-25) are at high risk for mental health, physical health, and substance use problems, yet they are falling through the cracks due to the lack of services aimed directly at this vulnerable population.

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Reflecting on Behind Bars: Ethics and Human Rights in U.S. Prisons

This is the first of a handful of posts and commentaries that I will post arising out of the Prison Conference called “Behind Bars:  Ethics and Human Rights in US Prisons.”  In it, Gali Katznelson nicely highlights some of the presentations and many of the issues that were raised over the course of the 2 day conference.

Reflecting on Behind Bars: Ethics and Human Rights in U.S. Prisons



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The urgent need to recognize and value academic labor

Two Harvard professors share their thoughts on the latest from the US Republican Party’s tuition waiver tax plan.

The post appears in Nature here:

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What Do Medical Students Know?

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Behind Bars: Ethics and Human Rights in U.S. Prisons

Behind Bars: Ethics and Human Rights in U.S. Prisons
November 30 – December 1, 2017
Harvard Medical School Campus, Boston, MA

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The United States leads the world in incarceration. The “War on Drugs” and prioritizing punishment over rehabilitation has led to mass imprisonment, mainly of the nation’s most vulnerable populations: people of color, the economically disadvantaged and undereducated, and those suffering from mental illness. Although these social disparities are striking, the health discrepancies are even more pronounced. What can be done to address this health and human rights crisis?

This conference will examine various aspects of human rights and health issues in our prisons. In collaboration with educators, health professionals, and those involved in the criminal justice system—including formerly incarcerated people, advocates, and law enforcement—the conference will clarify the issues, explore possible policy and educational responses, and establish avenues for action.

This conference is open to the public. Registration is required to attend. There is a $50 refreshment fee to offset costs for meals during the conference, and to reduce waste. If this fee would prevent you from attending, please contact the Center for Bioethics at 617-432-2570 for assistance with your registration.

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