Developments concerning the use of a "very addictive drug" (this is how MedlinePlus refers to meth) by a prominent medical school administrator and physician seemingly call into question the verities with which medicine regards and deals with drug use.
News item: The former Dean and current faculty at U.S.C.'s medical school, Carmen A. Puliafito, a world-famous ophthalmologist and highly successful fund raiser for the school, was summarily fired after news of his drug use was publicized.
What lessons can we glean from his story?
1. The Dean was highly successful while he was using meth, an amphetamine similar pharmaceutically to Adderall, a drug used by college students to improve concentration and performance. Meth is the drug associated with those pictures of people whose appearance deteriorates horribly due to their drug use. But there are no reports that Puliafito was impaired in his job performance; almost the contrary:
A renowned eye surgeon responsible for several breakthroughs in ophthalmology, Dr. Puliafito led aggressive fund-raising efforts that garnered more than $1 billion for the medical school. . . .
Dr. Carmen A. Puliafito boosted the medical school’s ranking as its dean and raised hundreds of millions of dollars, becoming one of the highest-profile figures at a university packed with star faculty and supported by big donors.
Around Los Angeles, Dr. Puliafito garnered attention as a kind of bon vivant at glittery parties, grinning for the camera alongside celebrities like Pierce Brosnan, Martin Short and Jay Leno while bringing in as much as $9 million in a single night.
2. Was Dean Puliafito addicted? In the first place, as I noted in Psychology Today in 2010, the psychiatric diagnostic manual (released in 2013) doesn't use the term "addiction" with regards to drugs, but reserves that term for gambling. DSM-5 requires for consideration of a diagnosis that the person experience impairment and distress. While we can't know the Dean's inner state, no such impairment and distress were reported during his successful tenure as dean, and he was fired only after an article about his drug use appeared in the L.A. Times a year and more after it occurred:
Puliafito, 66, and these much younger acquaintances captured their exploits in photos and videos. The Times reviewed dozens of the images.
Shot in 2015 and 2016, they show Puliafito and the others partying in hotel rooms, cars, apartments and the dean’s office at USC.
In one video, a tuxedo-clad Puliafito displays an orange pill on his tongue and says into the camera, “Thought I’d take an ecstasy before the ball.” Then he swallows the pill.
In another, Puliafito uses a butane torch to heat a large glass pipe outfitted for methamphetamine use. He inhales and then unleashes a thick plume of white smoke. Seated next to him on a sofa, a young woman smokes heroin from a piece of heated foil.
As dean, Puliafito oversaw hundreds of medical students, thousands of professors and clinicians, and research grants totaling more than $200 million. He was a key fundraiser for USC, bringing in more than $1 billion in donations, by his estimation.
It was only after the pictures were revealed in the L.A. Times that university administrators realized that anything was amiss:
“This was the first time we saw such information firsthand. It is extremely troubling and we need to take serious action.”
Taking this statement at face value, apparently there were no significant problems with Dr. Puliafito's performance and role at the medical school.
3. Does U.S.C. and its medical school really treat drug use as a disease? U.S.C.'s chief administrators and prominent spokespeople repeatedly refer to Puliafito's drug use as an addictive disease:
“It’s unfortunate that, in every profession, we find individuals who suffer from addiction."
“We certainly understand that substance abuse is a tragic and devastating disease.”
“We are concerned about Dr. Puliafito and his family and hope that, if the article’s assertions are true, he receives the help and treatment he may need for a full recovery."
But why then did U.S.C. instantly fire Puliafito, rather than referring him for treatment for his disease to what university administrators would undoubtedly declare are the world-class addiction treatment staff and facilities available at the medical school?
4. Was Puliafito as addicted, or more so, to a lifestyle and to sex as he was to drugs? I have pointed out in Reason Magazine that DSM-5's authors specifically rejected the idea of sex addiction. But Puliafito's drug use seems to have been very much associated with his social activities, and particularly with a woman who worked as a prostitute:
One woman told The Times that he was with her when she overdosed in a hotel room and that he had taken her to his campus office to use drugs. The woman, Sarah Warren, who worked as a prostitute, said they were “constant companions” after meeting in early 2015.
This all recalls the case of former D.C. Mayor Marion Barry, who turned to crack only as a distant second choice after a former girlfriend refused to give him sex, while he interrupted his drug use to find another woman:
They reminisce about their past drug use—Ms. Moore testified that there were more than 100 such incidents.
”So what do you want to do?” Ms. Moore asks several times, without using direct questions about drugs.
The mayor, unaware that she is secretly working with the police and is prepared to supply him with drugs, says he wants to have sex.
Ms. Moore fends him off after he makes several advances. Mr. Barry then asks about a woman, identified as Wanda, who was briefly in the hotel room at the time he arrived.
”Your friend mess around?” he asks.
Only after his efforts to have sex are repeatedly rejected does Barry resign himself to smoking crack:
The Mayor picks up the pipe, raises it to his mouth and lights it. He takes a long drag and holds the smoke. Then he repeats the process. Ms. Moore moves back into the camera’s view. ”You don’t want to take another one?” she asks.
”No, you’re crazy,” the Mayor replies. ”Let’s go downstairs and meet your friend.” There is a loud noise. ”Police!” a voice cries out.
And, so, I am sure, as good scientists and public health advocates, U.S.C., its medical school, and the entire medical profession will want to reconsider their views of and approach to drug use and addiction based on this latest case involving one of their own.
Although, if I had been their therapists, I would have recommended Dr. Puliafito not film himself and that Mayor Barry check the hotel room for wires. That's called "harm reduction."
Submitted by employment policy on July 26, 2017 - 3:08pm
This really is not about lessons learned this is about you writing about another persons decision making. You and most of the public know that most places of employment in America do require drug testing and employees are not allowed to use illegal or now legal MJ drugs. I doubt other than the workers at the MJ dispensaries you will ever see any work place policy that says your not fired for the use of drugs especially in public universities or government agencies.
Someone is so involved with employment policy that they use that name as their PT moniker?
I like to take PT's sights higher than employment policy. This is about how we view/define/deal with drug use/addiction.