“There you go again.”
President Ronald Reagan, 1980
“There is a paucity of evidence-based medicine in the world of eating disorders. … There’s not a lot of people doing clinical trials with a large enough patient population. So, you know, I’m not aware of a whole lot of good data … the field of psychiatry has not developed to the point where it can reasonably assign empirical probabilities to different recovery outcomes.”
Dr. Ken Weiner, Medical Director, ERC, August 27, 2015
ERC’s New Study
On December 18, 2018, the Eating Recovery Center (“ERC”) announced it was launching a new study examining elements of treatment that are necessary for “… successful reduction of and/or abstinence from binge eating and other eating disordered behaviors in a sample of patients with binge eating disorder (BED) and Bulimia Nervosa (BN).”
This study is going to be conducted through ERC’s Binge Eating Treatment and Recovery (BETR) Program. This self-professed “groundbreaking study” is intended to examine predictors of successful treatment in 100 consecutive patients admitted to ERC’s Residential and Partial Hospitalization program. Purportedly, patients will be followed throughout their time in treatment and for 12 months following.
According to ERC’s website, eight percent (8%) of American adults will suffer from binge eating disorder. In 2017, the approximate number of adults in the United States was 252,063,800. If ERC’s number is accurate, the number of adults suffering from binge eating disorders in the US is 20,165,104.
Therefore, at 100 patients, ERC will be studying 0.00000496% of adults suffering from this disease. To put this number in perspective, if you took the entire populations from the states of South Carolina, Alabama, Louisiana, Kentucky and New Mexico, and picked 100 persons randomly from a combination of these states (not from each state), you would have the same percentage of the number of adults suffering from this disease that are going to be studied. Again, these are ERC’s numbers and percentages are based upon the United States Census.
ERC’s study will not include any persons receiving treatment at any other for profit treatment center, non-profit center, university based facility, international facility or academic research facility located anywhere else in the world.
This study will take place despite the fact that ERC’s own CEO/Medical Director, in sworn testimony admitted that one cannot assign empirical probabilities to different recovery outcomes.
In ERC’s press release about this study, ERC claims: “To date, the BETR program has served over 1,000 patients in its brief five-year tenure, with excellent treatment outcomes and high patient satisfaction metrics. A recent survey of patients in the BETR program concluded that 88% of the patients stated “life is better” following treatment, with improvements in areas of stress management, sleep, management of health-related and medical issues, and decreased depression and anxiety symptoms along with decreased (or abstinence from) eating disordered behaviors.” [emphasis added]
88% ? If we were to review and study ERC’s published, past history of claimed satisfaction rate, then truly, “Something is rotten in the state of Denver … err.. Denmark.”
ERC’s Prior Claims
On its website, ERC represents to the general public that with regard to its Child & Adolescent Inpatient/Residential and Partial Hospitalization Programs, “… 99% of parents of child/adolescent patients report that treatment at Eating Recovery Center was helpful.” [emphasis added]
Ninety-nine percent (99%)!
We previously pointed out that this representation is really quite remarkable since the highest score awarded by the respected American Customer Satisfaction Index to any health care provider was… 76%.
But, purportedly ninety-nine percent (99%) of ERC’s patients report that the provided services helped. This statistical number, since it must be exactingly precise so as to not constitute a gross misrepresentation to the general public, was obviously computed only after ERC developed a fool-proof system whereby 100% of its patients and their families not only stayed in communication and remained responsive after they were discharged (or after the applicable insurance company decided to discharge their loved one and only pay for stepped down treatment) and 99% of them state that the treatment was helpful.
But, if that is the case, we now have a significant discrepancy in ERC’s numbers. In its recent press release, ERC reported that its Binge Eating Treatment and Recovery Program only had an 88% satisfaction rate amongst 1000 or more patients and their families. But overall, ERC is reporting a 99% satisfaction rate with its program. The only way to rectify this disparity and have all numbers be accurate is if you calculate the number of consecutive patients ERC would have to treat with a 100% satisfaction rate to raise the satisfaction rate of 88% for its BETR program to a satisfaction rate of 99%.
This number? ERC would have to treat 11,000 additional, consecutive patients with a 100% satisfaction rate, to bring its 88% satisfaction rate up to 99% for the program. ELEVEN THOUSAND CONSECUTIVE PATIENTS AT A 100% SATISFACTION RATE.
At this point, we could cite additional information indicating that employee morale at ERC has not improved, that employee satisfaction with their CEO has dropped to 46% and that the majority of the reviews from disgruntled employees pertain to ERC being more concerned about generating a profit than patient care. But, these issues were previously disclosed in prior articles and we wish to stay focused on the upcoming study.
The logical conclusions drawn from the facts, statistics and known information is that ERC is an entity that misrepresents its satisfaction rate, has numerous complaints about its working conditions from both current and former employees, places far too much emphasis on profit over people and more than 50% of those employees who reported were not satisfied with the leadership of the company.
Issues with the representations made by ERC’s Binge Eating Treatment and Recovery Program
Before addressing additional issues present within the parameters of the proposed study, we must first address another “interesting” representation with the BETR Program itself. In its December 18, 2018 press release, ERC represented: “ERC’s PHP for BETR, as with all of eating disorder programs, offers a unique standard of care as the program provides 80 hours of intense treatment a week.”
80 hours of intense treatment a week? For each individual patient? In its Partial Hospitalization Program?
A patients in ERC’s PHP program in 2017 reported the following: “In PHP, you see your therapist 3x a week, your psychiatrist 1x a week, and your dietician 1x a week. You also have one weekly rounds session – about ten minutes- where they go over what you need to accomplish. … There are also other “fluff groups” like art therapy … yoga and team building (karaoke, catch phrase, board games, etc). Expect a lot of busy work.”
As for the claimed 80 hours of intense treatment a week, that is really quite remarkable. Especially since ERC on its website represents to the public that its child and adolescent partial hospitalization program offers “11 hours of daily programming.” Even if this is done every day of the week, that is only 77 hours.
In short, there is no logical basis supporting ERC’s representation that its BETR program engages in 80 intensive hours per patient per week. This again demonstrates that any program can publish any representations it wants. Those representations do not need to have supporting substance, facts or merit behind them. And entities that abuse the public trust in such a fashion must hope that no one reviews the numbers, finds the discrepancies and publishes its falsehoods.
And our children continue to pay the price.
Obvious additional issues with the Study
To paraphrase Dr. Weiner’s sworn deposition testimony, clinical trials with small patient populations do not result in good data. The most obvious issues with the upcoming study based on ERC’s history and the press release include:
- A laughably low patient population;
- Only ERC doctors and professionals are involved;
- Not being overseen or supervised by independent outside third parties thereby giving some assurance of unbiased, quality control;
- The study’s disclosed, proposed protocol is rife with Confirmation Bias;
- The underlying data to ascertain the predictors of successful treatment were not disclosed;
- ERC did not disclose whether this study also involved a “double blind trial”;
- What objective findings and criteria are being relied upon to determine “success” of the program;
- What outside agencies, universities and research-based facilities are being used to ascertain and confirm that objective, professional results are going to be obtained;
- What raw data is being utilized and what entities are reviewing, studying and interpreting the raw data in an effort to convey some semblance of credibility.
The Obvious, Inescapable Conclusion
.00000496% of adults suffering from binge eating disorders are included in this study. The guinea pig patients are subject to ERC’s “standards” alone. ERC has a history of publishing grossly inflated success rate numbers in order to boost its “reputation.” According to its CEO, small patient populations do not result in good data and the field of psychiatry has not developed to the point where it can reasonably assign empirical probabilities to different recovery outcomes.
But, in anticipation of ERC’s presumably, glowing report which will be released in approximately 12 – 18 months, let us speculate as to the anticipated findings which will be disclosed:
“ERC is proud to report that of the 100 persons in this ground-breaking study, 98 reported significant improvement. ERC’s Exposure and Response Prevention Therapy to the treatment of BED and Night Eating Syndrome showed marked improvement in the overall moods of those 98 persons. Further, the medical markers we studied were able to establish a pattern of increased biological activity and symptom reduction as weight status was stabilized. In addition, as the significance of comorbidity increased, this in turn resulted in more intensive treatment for binge eating disorders which we properly diagnosed and treated. Following discharge, those 98 patients showed a remarkable ability to reacclimate themselves to mainstream society and thanks to us, their skill acquisition improved.”
But … let us assume arguendo, this “ground-breaking” study does not result in the success rate ERC anticipates. What if instead of the anticipated 98% satisfaction rate with this study that we expect ERC to publish, the raw data instead indicates not only was there no improvement in the majority of the 100 guinea pig patients, but many of those patients showed regression? Would these results be published at all? If so, wouldn’t this be an indictment of ERC’s treatment protocol, if not possible medical malpractice? This would inevitably result in a probable loss of future revenue stream. When you consider that in the next five years, ERC has one quarter of one billion dollars in debt which comes due and must be addressed. $250,000,000.00. This study has no published criteria. This study has no outside parties involved. And ERC has a very substantial financial incentive to be less than forthcoming.
ERC had the opportunity to initiate a broad based, industry wide study which could have included all of the treatment centers in the Residential Eating Disorder Consortium and the brilliant leaders in the academic and research communities. This type of study is tailor-made for collaboration amongst colleagues. Dr. Weiner sits on the REDC’s board of directors with professionals from 5 other treatment centers all of which could have been included. Imagine, a study which would have been inclusive of other major treatment centers, their doctors, scientists, medical professionals and patients. Imagine, the signal that would have been sent … that it IS about the power of the message … and not the image of the messenger. But that $250,000,000.00 in debt is not going to repay itself!
ERC started down the path of false statistics and misrepresentations regarding their satisfaction rate a few years ago. To anyone who studies ERC’s statistics and misrepresentations, and to those who have access to a certain deposition transcript, the prevarications are obvious. And now, we will be left with a so called “ground-breaking” study whose results will be subject to wide-spread criticism if not outright derision. A study that will help no one but will undoubtedly be used to bolster already suspect satisfaction rates.
And all the while, our loved ones continue to die.