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“Fighting Fire With Fire,” by Megan Feldman, August 14.
Not High on Prometa
I am a clinical researcher and an addiction psychiatrist practicing in Dallas. I think Ms. Feldman’s article succeeds in pointing out some of the controversy surrounding Prometa but falls short in providing a balanced clinical perspective.
The article provided the testimonial of three individuals for whom Prometa seems to have worked. I am wondering why there was no balance in reporting the testimonials of those who did not succeed on Prometa. I and others in the treatment community have treated individuals for whom Prometa was just another promise of a cure gone unmet at great financial cost to them and their families. It’s too bad the voices of these people were not given equal time in the article, and there was not even a mention that there is a population of individuals who feel less enthusiastic about the treatment.
There is no doubt that a combined medical and intensive behavioral program can often lead to sustained recovery from addiction. As a clinician I honor and applaud the success of those who have achieved sustained recovery after undergoing the Prometa Protocol and continue to work hard at their recovery. I, however, remain skeptical of the unproven and highly speculative scientific claims made by Hythiam Inc. Hythiam has not demonstrated [whether] the improvement seen in Prometa patients is the result of the drug cocktail itself or the powerful placebo effect seen in any highly orchestrated medical procedure followed by intensive behavioral therapy. There are proven, far less expensive ways to help give people a “jump-start” in recovery.
Ultimately, I think the lay readers will still be left scratching their heads after reading this article. I also fear an addict or concerned family member will read about the success stories presented in this article and opt for an expensive, “experimental” treatment without getting the other side of the story from those for whom Prometa was a failure. Fortunately, data from two randomized control trials performed at established academic centers will be available soon, and we’ll all be able to decide if Hythiam’s rush to forgo the rigors of scientific testing is based on a “moral imperative” or imperatives far more profane.
Carlos F. Tirado, assistant professor of psychiatry at University of Texas Southwestern Medical Center and medical director of Nexus Recovery Center Inc.
“Low-Bid to No-Bid,” by Jim Schutze, August 14
Blaming the Wrong Screwups
You left out a key part in your explanation of the “construction manager/general contractor” process. During the pre-construction phase, the contractor gives DART a “guaranteed maximum price,” or GMP. If DART is not happy with that price, they can open the contract to competitive bidding. DART was not obligated to award a contract for construction (that would be the big-dollar one) to the same company that did the preconstruction services (the smallest contract). The fact that they chose to do it just means that they must have been satisfied with the GMP.
The point of this “CM/GC” process is that once the construction contract has been awarded, the contract value cannot grow. The problem with normal competitive bidding is that contractors bid low to get the job and then later have their lawyers come up with reasons that they are entitled to more money. The concept of the GMP is supposed to stop that, at least in theory. The contractor gives up a lot of its rights to seek additional money when it goes through these preconstruction services with DART. The preconstruction process is where the contractor and owner work together through the final design to eliminate the unforeseen problems that often occur in construction and raise the price of a contract.
The fact that DART is now a billion dollars short on its planned expansions is a completely separate matter. All it means is that when the projects were planned years ago, some consultant estimated the cost at $1 billion. And today another consultant estimates the cost at $2 billion. No one has committed to build any of it for any price. If the bids come in at $3 billion, then both consultants were wrong. More likely the original estimate was way too low to begin with. So yeah, someone screwed up, but no contractors have been involved in any of it yet.
Louie, via dallasobserver.com