Jan 12, 2008

Upcoming Contractor Drug Testing Video Conference: January 16, 17, 22, and 23, 2008

10 CFR 707
Workplace Substance Abuse Programs at DOE Sites
Public Forums via Videoconferencing

The public forums on the new drug testing and security clearance requirements for DOE contractors are scheduled for January 16, 17, 22, and 23, 2008, from 1:30 to 4:30 p.m. (Eastern Standard Time). The purpose of the forums is to give each contractor affected by the new requirements the opportunity to voice their views and assist the Department in identifying any issues requiring resolutions. The forums will be conducted via videoconferencing at DOE sites. Attached is a list of the videoconference sites with a call-in number for telephone participation. Please note videoconferencing will be linked on a first-come first-serve basis for each day. If you have any questions regarding the videoconference, please contact Bill McArthur or Jacqueline Rogers. Specific questions regarding video links and setups should be directed to HSS User Support at (301) 903-8358.

Additional information regarding drug testing requirements is located at: http://www.hss.energy.gov/HealthSafety/WSHP/rule851/rule707.html.


Anonymous said...

Why do I think that comments in the video conference will be just like the comments made in the contract change - thanks for your input, we already have made up our minds, this is the way it's going to be.

I had thoughts of my post lab career as being a greeter at Walmart. Maybe I can switch and pass out urine sample cups instead. You want a happy face sticker on that one?

And as an aside, when you visit the link in the original post you'll find one of the documents in MS Word format. Now why can't DOE / NNSA send out documents in PDF format that are less susceptible to viruses? They did the same stupidity when the put out the documents on contract change as well.

And finally, to save time will they have us hooked up to the polygraph machine while we are supplying the sample? Don't pee on the wires please.

Anonymous said...

Has Mike taken the piss test yet? Have any of his PADs or ADs? How about the polygraph? Have they been tested for their loyalty through the use of interrogation with low tech voodoo-magic? And what about the LANS board. Has LANS Governor Gerald Parsky been fully tested? Just curious. I wouldn't want one of these people in such a high position to end up being a disloyal mole who could hurt our national security. You never be too sure about these things, right?

Anonymous said...

I have been very pleased with the job the Laboratory is doing with the drug testing program. I have been called twice and in both cases, the technicians were professional and well trained. I have been told that the program has resulted in several workers being removed from the Laboratory after testing positive. The more workers who are fired for using drugs, the happier I will be. No one should be defending drug users at this Laboratory.

Drug use cannot be tolerated at this Laboratory.

Anonymous said...

Good enough for Orlando Smith, just do not take through airport security:


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Anonymous said...

"Drug use cannot be tolerated at this Laboratory."

Which suggests it can be tolerated someplace else?

Anonymous said...

I'd have to agree with 3:14. The timing and circumstances surrounding the enforcement of the drug testing policy was just unfortunate given the LANS changeover. It's hard to bring down even a reasonable shift in policy in an environment where people are so stressed and paranoid that they push back on everything that possibly can be seen as a management versus them situation.

Anonymous said...

2:17 pm: "Has Mike taken the piss test yet? Have any of his PADs or ADs? How about the polygraph? Have they been tested for their loyalty through the use of interrogation with low tech voodoo-magic?

Yep, in fact most LANS upper managers are in the program. Just look for the yellow strap on the badge.

Anonymous said...

"Which suggests it can be tolerated someplace else?"

Yes, sparky. How about Amsterdam? Or College? Or anywhere that anal pricks (ewww!) like you are not in control.

Anonymous said...

"Drug use cannot be tolerated at this Laboratory"

Seriously, will it be worth firing some lab scientists because they tested positive after taking Nyquil? Who wins in that case?

from the web:
"There are more than 250 over-the-counter medications and prescription drugs that could cause a false positive."

Anonymous said...

"Drug use cannot be tolerated at this Laboratory."

What is worse? Someone smoking a joint once a month or somone who is drunk almost every night?

I would rather trust someone who smokes a joint every now and than than some drunk.
Like it or no LANL has a lot of people who fall into the latter category.

Here is another one. Who is less trustworthy? A rational person who smokes a joint once
a month or a person with crazed religious ideals? By the way I highly recomend Dawkins book, "The God Delusion". Sam Harris has some great books as well.

What is the next thing they will test for or want to know? What is your sexual preference?

Of course most of this could be solved if we just hired better people in the first place. Old story.

Anonymous said...

7:11 pm: ""Drug use cannot be tolerated at this Laboratory."

Which suggests it can be tolerated someplace else?"

Why yes, it is and will be tolerated (at least recreationally among the upper classes), in most countries in the world, including the US. Hadn't you noticed that Los Alamos has one of the most active and varied (almost up to the level of Santa Fe) drug-using populations in the West? Especially among teen-agers? Only those with security clearances need to worry.

Anonymous said...

1/12/08 10:01 PM

"What is the next thing they will test for or want to know? What is your sexual preference?"

"Sexual preference," but also "information on finances," and "psychiatric care," has been forced upon scientists at NASA´s JPL should answer in an background check to their officials, but a group of scientists there has sued the administation over this new harsh domestic security check.

A brute fact to your question is: EVERYTHING.

(You find my full post below, Saturday, January 12, 2008, Departing Scientists Eye Future, 1/12/08 6:36 PM)

Anonymous said...

Contacts are also important. Employee friends, neighbors and even past work relations should also be required to take piss tests. You never know when these people might influence an employee to smoke a joint, so it is best to test them all now.

Anonymous said...

A search of the literature will quickly show that the problem of false positives exists with urine drug testing. Unfortunately, the LANL policy is to immediately terminate anyone who does not pass this test.

If they modified the policies to more thoroughly target the guilty and pass on the innocent, I would have no problems with the testing. As it is, you can be sure that some good staff will probably have their lives destroyed for no good reason.

Anonymous said...

From Wikipedia.org, "List of MythBusters special episodes," Pilot 3 - "Larry´s Lawn Chair Balloon, Poppy Seed Drug Test, Goldfinger," Original airdate: March 7, 2003:

Myth statement: "Eating poppy seed bagels or poppy seed cake can cause one to test positive for heroin and/or opium on a drug test."

Status: "Confirmed."

Notes: "Heroin is a semi-synthetic opiate made from Morphine. If a test is sensitive enough it can generate a false positive simply by detecting the poppy seeds. Lawsuits have actually been filed and settled due to this phenomenon."


(I did see the show, and due to a scientific point of view, I consider the test to be questionable, due to the fact, that it to often record to small of amount of opiates, e.g. "poppy seeds," to eat poppy seed bagels, doesn´t make you a drug user, or junky.)

Anonymous said...

" the LANL policy is to immediately terminate anyone who does not pass this test. "

Looks like a lawsuit waiting to happen.

Anonymous said...

It's a fact that drug use has led to spying and the release of national security information by those holding security clearances. So far, I haven't seen any suggestions by any of you smartasses out there as to how to mitigate that potential without testing. Anyone? Anyone?

Anonymous said...

" the LANL policy is to immediately terminate anyone who does not pass this test. "

Looks like a lawsuit waiting to happen.

You are right however that is not the point. The point is to create fear and misstrust. Sure they may lose a lawsuit or two but it will be worth it for them.

Anonymous said...

Just curious...how many times have people been called? I just had my 4th. And unlike another user here, in every encounter I have had with them, they have been threatening and arrogant.

Anonymous said...

Turns out the industry-wide false positive cutoff level was raised to account for the presence of opioids from poppy seeds. There is a detectable signal from poppy foods, and the analysis interpretation was changed to deal with this. It is not a myth.

If one digs around on the web for legitimate scientific journal papers on drug testing, and literature from the drug testing companies, it is evident that the industrial scale trace analysis industry has to deal with trace contamination issues. That means, every single urine sample shows a small but nonetheless real level of every molecular target analyzed. Thems the breaks. There are limits of detection, limits of quantitation, and blank contamination. For example, the "negative" level of say methamphetamine might be 70 ng/L, so that a measured amount of 55 ng/L from a real drug user is listed as "negative".

The fewer the number of real drug users in a tested population, the larger the proportion of positive tests that are false. There are ALWAYS false positives. In a population with zero actual drug use, ALL the positive tests are false.

If people use drugs, they are breaking the law and the rules, and they get what's coming to them. A few innocent people will have their lives devastated by this program for no reason.

Drug testing will destroy the careers of a few innocent people: that is certain. Does that cost justify the illusory gain in security? Last I checked, all the successful LANL spies throughout history were not drug users, they were professionals driven by ideology to obtain secrets for their countries.

Testing should only be done for clear cause. Did you get a bunch of cash out of an ATM and maybe get a microscopic piece of cocaine on your finger? Wash you hands before you pee. And hope nothing in the liquid soap resembles a drug molecule.

Anonymous said...

"It's a fact that drug use has led to spying..."

Oh, is that a fact. Any particular instances you care to cite, fact-boy.

Anonymous said...

"If people use drugs, they are breaking the law and the rules, and they get what's coming to them."

What's coming to them = treatment, if you are wealthy and white.

What's coming to them = prison, if you are not wealthy and white.

Or as Mel Brooks said - "it's good to be the king!"

Alan Zelicoff said...

From Al Zelicoff MD
[Comments welcome at: zalan8587@qwest.net]

While I think it likely that the public comments on the Drug Testing policy at DOE labs will be anything other than a pro-forma event without any serious intent to listen to the considered scientific views of laboratory staff (much like the polygraph hearings held by then-Secretary Richardson in 1999 and 2000), it may be useful to at least introduce the known literature on the utility of drug screening in environments that are, if anything, arguably more consequential than employment at a DOE: hospital settings where intoxicated staff can act in direct detriment to the interests of patients. (I accept, a priori, the potential demogogary that can obfuscate the relative likelihood of harm, but it is trivial for the considerations presented below.)

Attached are two recent reviews – they are quite representative of the broader, well-documented literature on the subject -- and to the best of my knowledge there have been no studies that have countered the conclusions of the work abstracted below: drug testing is almost certainly than worthless (indeed, just as polygraphs are) for deterring or reducing the probability of drug use while at the same serves as a bludgeon that even further undermines employee moral and sensibilities, especially in a highly trained and -- even by admission of the DOE -- very loyal staff whose commitment to their work is about as good as it gets anywhere in government circles.

Copyright rules prevent me from posting the full text of these articles to a website, but I can send the entirety of the articles (and indeed others as well) to readers of this site who wish to see the data in its fullness. Please feel free to contact me directly and I will send the articles in .pdf format for individual use. Perhaps they will be a use during a reasoned discussion if the forum is something other than a box-checking exercise (and the comments preceding this one are probably correct in concluding that it won't be.)

My personal belief is that DOE and laboratory management while doubtless itself made up of intelligent folks with scientific training is out of its league (or bona fide training) when trying to weight the medical benefits and downsides of random drug-screening in a national security setting (for what its worth, my experience at Sandia was that eve though the Occupational Medicine department was well versed in adverse risk/benefit ratio of screening of any kind in the absence of cause, they were unwilling to so inform management and stick with the science at the risk of their own careers.)

At the very least, for the record, management and the DOE should be called to task to comment on what they know that long-standing respected, well-published experts in the field of random drug screening don’t know – and even to offer their own evidence of the utility of such an approach -- though I am dubious that they have any data at all. Instead what they offer is an attitude when it is intellect and careful policy planning that is required to preserve what remains of both internal and national confidence in the Labs.

One final point: in addition to the detrimental effects on random drug screening per se on individuals (false positive being but one example; there are many others as the articles below make there) , there is one other pernicious impact: diversion of security resources where they could be much employed if Laboratory directors and the DOE truly were interested in improving security instead of grandstanding.

Regrettably, as with Secretary Richardson's tawdry, dismissive treatment of precious scientific staff during his ill-fated polygraph program, the current leadership in the Labs and the Department are confusing doing something with doing something useful . This key conclusion deserves repeating – loudly and with solid science backing it up. The latter is, of course, the lesson of the polygraph program. Perhaps taxpayers and candidates for high political office in NM will take note as well should a few brave souls at LANL and elsewhere in the DOE community make their voices heard. There is no question that principled protest rests on solid scientific ground.

Al Zelicoff, MD

MacIntyre D et al. Substance misuse in a high security hospital: Three years
of urine drug testing at the State Hospital, Carstairs
ABSTRACT With the increasing evidence for the significant contribution to
violence made by alcohol and drug misuse in people with mental disorder,
there is emerging evidence of the importance and increasing prevalence of
substance misuse problems in patients admitted to high security hospitals in
the UK. Recorded routine voluntary urine drug screening of patients at the
State Hospital, the high security hospital for Scotland and Northern Ireland,
started in 1998. Results of urinalysis over the 3 years from 1 January 1999 to 31
December 2001 were examined. Out of 7,069 samples sent from 421 patients
there were 712 (10.1%) positive results. The majority were false positives (672;
9.5%) due to prescribed medication, with only 40 (0.6%) true positives. All
the true positive results in the admission unit were related to substance misuse
prior to admission, the remaining true positive results were all within the
continuing care wards, with no true positives in the rehabilitation wards. Even
though the testing was not truly random, it is likely that the findings reflect
extremely low levels of substance misuse within the hospital in contrast with
findings from UK prisons. Whether urine testing contributes to the prevention
of drug misuse within the hospital is unclear, and there are potential ethical
and legal concerns about the urine testing process. It is important that high
security hospitals are virtually drug free, to enable the uncontaminated
assessment and treatment of mentally disordered offenders.
The Journal of Forensic Psychiatry & Psychology
Vol 15 No 4 December 2004 606–619

M R Levine, W P Rennie. Pre-employment urine drug testing of hospital employees: future questions and review of current literature
Correspondence to:
Assistant Professor M R
Levine, Division of
Emergency Medicine, 676
North St Clair St, Suite
2125, Chicago, IL 60611,
USA; mrlnyc@aol.com
Accepted 28 May 2003
. . . . . . . . . . . . . . . . . . . . . . .
Occup Environ Med 2004;61:318–324. doi: 10.1136/oem.2002.006163
Background: Patient safety and optimisation of worker performance are high current priorities. Arguments over employee drug testing have been debated over the past two decades. Aims: To review prior information to reveal how current principles and practices regarding pre- employment drug testing of health care workers evolved, and to explore pressing current and future issues. Methods: A literature search of Medline from 1980 to 1999 was performed. This yielded seven citations that reported results of pre-employment drug testing of health care workers, which we critically reviewed. Results: The process by which a rational testing process was developed for pre-employment urine drug screening in the health care field is illustrated. Also depicted are some important principles, inequities, and shortcomings of the system. The range of positive tests was wide, from 0.25% to 12%. Testing was not always applied uniformly to all health care workers. It became apparent that positive tests also require medical review to determine if they were truly due to illicit substance use. Conclusions: Although pre-employment drug testing programmes in the health care industry have been firmly in place for many years, it is unclear whether such strategies have achieved their stated purposes. The next step is to study whether such programmes are effective at accomplishing specific goals, such as decreasing absenteeism, turnover, accidents, and medical errors, in order to justify continuing pre- employment testing versus changing to an alternative testing strategy.

Anonymous said...

5;20 pm: "It's a fact that drug use has led to spying and the release of national security information by those holding security clearances"

No facts that I can find anywhere support this. No one ever alleged that Wen Ho Lee was on drugs, and that is the only instance in DOE (since the Rosenbergs) where there was real, confirmed, loss of classified information (the seven tapes never recovered). What is your other evidence or facts? It seems that drug use has not, in fact, "led to spying", at least not at LANL or other DOE sites. If you are referring to losses from other agencies, they why don't THEY test all employees for drugs??

Anonymous said...

I've been called one time and things went pretty smooth. I had to wait about 10 minutes. The scheduling leaves a little to be desired.

Are all employees required to participate? Has Mikey been called or does he get to bypass the program.

If LANL already does drug testing, what is DOE going to teleconference???

Has anyone been able to refute a false positive at LANL? I know two employees who were fired...they both smoked weed on occasion.

Anonymous said...

According to POGO, the computer Jessica Quintana used at home to catch up on work "was traded in exchange for drugs."

"Ms. Quintana allegedly broke down during an FBI polygraph session and indicated the computer she was using to work with the information on the memory sticks was now missing.

The computer remains missing."

Anonymous said...

Dr. Zelicoff,

One question- Are you saying it is worthles to try and detect workers who are using illegal drugs (and thus possibly impaired and a danger to their fellow workers?

And please stay away from the polygraph issue and stay focused on this subject. Surely you used IA and GCMS to detect drugs in your medical practice and you are are familier with their scientific validity.

Anonymous said...

"A computer which may have contained highly classified nuclear weapons information from the Los Alamos National Laboratory was traded in exchange for drugs, according to unconfirmed sources."

The "may" and "unconfirmed sources" did not make it into your quotation.

Anonymous said...

" Drug use cannot be tolerated at this Laboratory.."

Speak for yourself. A little taste of sildenifil allows one to rise to life's challenges....

Anonymous said...

" Which suggests it can be tolerated someplace else?

lighten up. see Barak Obama's bio
think Charlie Wilson. welcome to the united states of hypocrisy.

Anonymous said...

"Dr. Zelicoff,

One question- Are you saying it is worthles to try and detect workers who are using illegal drugs (and thus possibly impaired and a danger to their fellow workers?"

As someone cogently pointed out regarding doing something vs. doing something useful; from a safety point of view, you would be better off doing random breathalyzer tests after lunch. The data would be more reliable, and the nexus with safety more clear.

Anonymous said...

two employees who were fired...they both smoked weed

Fired for smoking weed?
Silly compared to what Nanos did

Anonymous said...

Regarding the "what is worse - alcohol or [insert illegal substance here]" argument. While I agree that things like pot are probably alot less destructive than alcohol, it's not about the effect of the drug. Someone who shows a pattern of behavior where they selectively choose to follow or disobey laws (of the more-important-than-traffic-violations variety), it should be clear evidence that they are less trustworthy than someone who chooses to live a life where they follow laws that they may disagree with. I don't think the safety argument is the only argument around the lab -- in an environment where trust is important, I'd pick someone who follows the law over someone who picks and chooses which laws they feel apply to them.

Anonymous said...

It's so very special how LANS has arranged to have the piss-mobiles parked out front of Otowi Building each morning so that workers can see them when they arrive. It's as if LANS is openly telling everyone, "Don't think we trust any one of you even for a minute".

They could be more discrete about all this, but the main thrust of this effort is based on the concept of intimidation, much like the efforts at polygraph testing. And I can assure you that no Director, Dep. Director, PAD, or AD will ever fail a piss test, no matter how many poppy seed muffins they had for breakfast. Of course, it's unlikely they'll ever be called to make a piss donation.

Anonymous said...

8:14: I agree with you that the claim is somewhat unsubstantiated. I would tend to believe it though. One of the factors in a security investigation is identifying potential things that someone has done that can be used as blackmail fodder. If one is an occasional pot smoker or other drug user, it would be a clear blackmail issue where one can be compelled to provide information in exchange for this behavior not being revealed to the employer resulting in them losing their job. This is called out as a factor by other organizations (see "security concerns" on this page). That link also seems to agree with 9:35.

Anonymous said...

" I'd pick someone who follows the law over someone who picks and chooses which laws they feel apply to them."

Good point! However you would have no problem with all the people who
where involved with the major spy cases in the United States.

Jonathan Pollard

Walker Spy ring,

Ronald Pelton

Harlold Nicholson

Robert Hanssen

Aldrich Ames

Edward Lee Howard

Brian Regan

Lawrence Franklin

Peter Lee

Manriano Fagot

Edwin Pitts

George Trofmoff

Christopher Boyce

It seems to me that the best ways to get spies into certian places is to have drug and polygraph testing. The real spies will pass these tests and be highly trusted since the did pass these tests. I can see it now! He/She cannot be a spy, they passed the drug test!

This is the problem with drug and
polygraph testing. Neither can spot real spies and they create a false sense of reassurence that people who do pass are somehow really trustworthy.

Polygraphs and drug tests are great assets to our enemies.

Anonymous said...

"Has anyone been able to refute a false positive at LANL? I know two employees who were fired...they both smoked weed on occasion.

1/13/08 8:29 PM"

Great, I know some people who drink so much that they would would say anything to anyone on a Fri night. Hey but thats cool. I feel safer now.

Alan Zelicoff said...

First, a direct answer to the questions posed to me:

1. It is very important to understand that there are two types of false positives when doing screening. The first is a technical false positive (that is, that the technique incorrectly identifies the presence of a substance – in this case, one that is ostensibly illicit or prohibited for whatever reasons) and an interpretational false positive – that is, drawing an incorrect conclusion from the presence of that substance, or equivalently, divining the wrong meaning from the presence of the substance. [By the way, there are clear cases where the presence of a certain drug is unambiguously illegal and/or cause for dismissal in a high-security environment: cocaine, methamphetamines, heroin are the clearest examples. But codeine – a derivate of opium, valium or its numerous cousins, or alcohol may or may not be. I would note that alcohol is rarely detected in urine during working hours because its half-life is short. But take a sleeping or narcotic pill on Friday night and either the drug or its metabolites will be in your urine on Monday morning. Is that cause for dismissal? Most would say not.]

2. Apropos Anon. 1/13.08 9:11PM: It is not worthless – based on the literature – to try to detect workers who are using illegal drugs. It is worthless (or worse) to do so in a random, screening mode as opposed to for cause. So, for example, if someone is behaving oddly and/or actually makes errors whose consequences are reasonably regarded, singly or in aggregate, as placing people or information security at risk then the presence of one or more drugs (or their metabolites) in urine or blood has a much much higher likelihood of being causally linked to the aberrant or abnormal behavior. I realize there is a judgment involved with the word “reasonably”, but that’s what good management gets paid to do.

Thus, the bottom line is this: drug-screening does more harm than good when used randomly BUT does more good than harm when used selectively (“for cause.”) Unfortunately – and there is no way to avoid this – under the latter policy doubtless someone, somewhere, sometime will abuse drugs that will probably lead to an undesirable or catastrophic consequence. The former policy (random screening) will certainly lead to some people losing their jobs/clearances (indeed it has already happened; see below.) The proper policy is to: (a) state that employees are subject to drug screening for cause; and (b) to have a knowledgeable addiction specialist (not just any ordinary MD, RN or pharmacologist) interpret the results if positive.

Since I’ve been involved, as a matter of public record, as an expert witness in cases where employees have lost their jobs due to a positive drug screen, I am permitted to state that in my experience (it is not small) in each case the employee/defendant had their jobs restored because the employer had made the second type of “false positive” conclusion. To the best of my knowledge (I could be wrong), DOE doesn’t have an internist-addiction specialist at its disposal. Like much of the practical application of science, there is a lot of the devil in the details.

Now to expand a bit (for those who wish to read further):

The limitations of random screening have been known for twenty or more years in medicine, which explains why only about a half-dozen screening tests for disease (despite the availability of dozens more) are actually recommended by the US Preventive Services Public Health Task Force as “evidence-based” or “best practices”. The guidelines for selecting screening tests to be used in a random fashion are based on the following characteristics (I paraphrase here) by the USPSH Task Force recommendations:

• early detection by screening is synonymous with a disease (or a problem of consequence) and also makes a difference in treating a disease (or dealing with a problem)
• the potential for harm from starting down a long diagnostic cascade from the original screening test with multiple additional tests is small.
• The test itself has limited risk
• The disease the test is designed to detect can, in fact, be treated with a high percentage of success or cured; and
• The treatment of the disease doesn’t result, on average, in side effects that are as bad (or worse) as the disease itself.

While I’m sure most readers of this page can probably translate this medical checklist into the closely-related realm of drug screening, the guidelines emphasize derive from the discipline of classical systems engineering and, in particular, considers downstream consequences. This is precisely, in my view, what is absent in the DOE drug-screening policy (but again, I may have missed something). There is no literature evidence from multiple working environments where, in theory, drug abuse could be highly and adversely consequential --transportation and healthcare being the leading examples – that random drug screening makes any difference in achieving the theoretical benefits (examples are already pointed out by other posters); but there is abundant evidence of harm to individuals and to organizational morale.

At the risk of going on too long, consider the following real-world example from daily medical practice: screening for hypertension vs. screening for prostate cancer. It may surprise some readers but I believe has valuable analogies in the putative random drug screening program.

Having one’s blood pressure checked is a good idea because (a) the consequences of high blood pressure are very well known; (b) hypertension is consequential (e.g. stroke, heart attack) and (c) early intervention and treatment does indeed make an enormous difference in outcome. At the same time, (d) the test results are almost always unambiguous (elevated blood pressure can’t be confused with much else) and (e) a long diagnostic follow-up is virtually never needed. Put another way, hypertension is synonymous with a problem that should be treated and where the outcome is almost always beneficial (and for those who wonder, cost-effective as well.)

Contrast that with a PSA test for prostate cancer – which is not recommended by the USPHSTF (yes, I know: many doctors still order the test routinely anyway). In this case, the assay itself is highly accurate (that is, if “prostatic specific antigen” (PSA) is present in the blood it not only will be detected, in its absence it will NOT be detected (so there are no -- or at least very few – “technical” false positives). But an elevated PSA is, unfortunately NOT synonymous with a problem that needs to be treated. The worry is prostate cancer, but the overwhelming majority of men with elevated PSAs do not have a disease that will cause them any problems, ever, even if the painful follow-on testing (a half-dozen or so prostate biopsies; ouch) shows abnormal cells. In most cases we just don’t know who among the biopsy-positive population is at risk for metastatic prostate cancer and who isn’t (fewer than 3% with biopsy proven abnormalities will ever have any symptoms, let alone mortality, from prostate cancer) . Finally, the treatment (or if you prefer “intervention”) options for the alleged problem are fraught with side-effects in somewhere around 20-30% of recipients.

Now some individuals may be willing to make the trade-off with regard to prostate cancer screening (e.g. accepting a 15% risk of urinary incontinence and a 10% risk of other problems after prostate resection in the hope of avoiding metastatic prostate cancer in the future – and yes, metastatic disease occasionally occurs despite aggressive treatment) just like some people may be willing to make the trade-off of dismissing people with positive drug screens even when most are no risk to anyone, including themselves. In the case of PSA screening, it’s the choice of a (presumably well-informed) patient; in the case of random drug screening, it’s the choice of someone else who doesn’t bear the consequences. Of course, from management’s standpoint, there is a potential legal liability in so doing as already noted above, and management would be well advised to think through those liabilities (though I doubt they have or will.)

To sum up: there is a natural human bias that “more information is always better” and there is a pervasive belief “modern drug screening doesn’t have much in the way of false positives”. As I’ve tried to emphasize when asked by the media (but the explanation takes longer than 30 seconds so I’m rarely quoted correctly), more information can (and in medicine often does) do more harm than good and the question when a drug screen is positive is rarely “whether or not the drug is actually present” but instead “what is the meaning of the drug being present?” In the context of aberrant behavior, the latter is usually easy to answer.

I don’t think that many minds in DOE or laboratory management will be changed, but I believe it valuable for staff to put the marker down so that when the inevitable future interpretational false positive (followed by an employee’s dismissal) occurs there will be some motivator (it may be legal action; I hope not) for DOE policy be re-examined in the light of known science (so far rather studiously ignored, it seems to me). It is heart-breaking to see that DOE is not learning from the published literature on random drug screening. Individuals will be hurt (and important programs will also suffer with the loss of talented staff) and costly legal actions may follow.

Anonymous 1/14/08 1:13AM summary sentence captures the lesson very well.

Hope this helps.


Anonymous said...

Hey how about this, if you don't want to take random drug tests, go work somewhere else. I solved the whole problem all by myself.

Anonymous said...

"Hey how about this, if you don't want to take random drug tests, go work somewhere else. I solved the whole problem all by myself.

1/14/08 5:53 PM"

This will NOT fix the real problem.

Anonymous said...

1:36 AM "Great, I know some people who drink so much that they would would say anything to anyone on a Fri night."

That describes my group leader down to a "T". Drinking was more important so he had to give up his blue badge. Nice, isn't it? But that is ok since he is best friends with the AD and DL and so everyone who should care is simply looking the other way. I am a bit confused because I thought security was important especially after Jessica Q.

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