Heartfelt congratulations should go to The National Health and Medical Research Council in Sydney Australia (“NHMRC”). The impending announced research study funded by the NHMRC and to be conducted by researchers at two major Children’s Hospitals in Australia is already incredibly successful, not just on a national scale in Australia, but internationally as well. And for this, the doctors and medical professionals who will be participating in the study should be lauded.

But, it is not for the reasons those medical professionals may believe.

In the eating disorder industry, it is very rare, perhaps non-existent for the vast majority of players (organizations, doctors, counselors, dieticians, advocates, families) to “circle the wagons,” to unite and speak with one clear, unambiguous voice on any issue, let alone an issue that may be regarded as controversial. Silo mentality in the eating disorder industry is prevalent. The race to become the next Jonas Salk permeates the industry. And so, the thought that a single issue could arise which would unite all factions seemed unlikely at best.

No longer.

The international eating disorder community became aware of the aforementioned research study to be conducted by the NHMRC. This twelve (12) month study is to be performed on children from the ages of 13 years to 17 years of age who are classified as “well above a healthy weight.”

The Study requires the children to follow extreme calorie restriction diets (800 calories per day) for one month, and not in a laboratory or carefully controlled setting. This is to be followed by 12 months of low calorie dieting for half the participants, and alternate day fasting for the other half. Children in the fasting group will eat just 600–700 calories a day for three days a week, approximately 25–35 per cent of estimated daily energy needs. The remaining four days will be a “standard diet.”

These children and their parents will be required to closely monitor the children’s daily food intake not only at home but at school as well to make sure that the exact amount of caloric intake is strictly followed. Nothing like pristine laboratory conditions capable of being duplicated in future studies!

The outcry from the eating disorder community started as a whisper, became a loud talking point and has now escalated to become a mighty roar. Counselors, doctors, dietitians, organizations and advocates in Australia and New Zealand began to communicate, collaborate, review the published proposed trial study and organize a unified response. Clinical psychologist Louise Adams organized industry replies to this ill-advised research study. Her blog article can be found here: https://untrapped.com.au/lets-not-spend-1-2-million-starve-teenagers/

The preeminent eating disorder foundation in Australia, The Butterfly Foundation, in conjunction with the Australia & New Zealand Academy for Eating Disorders, Eating Disorders Victoria, and Eating Disorders Queensland issued a joint release stating in part:

“Eating disorders are complex neuropsychiatric illnesses with severe mental and physical implications. Given such, we still have concerns and believe further action is required.

In discussion with the principal researchers involved in the trial, we have requested the following:

• The risks of developing an eating disorder are clearly stated in the participant and parent information sheets, and on the trial website;
• Additional psychological support for participants throughout the trial;
• Additional screening for anxiety and distress at key points during the trial;
• Specific training in Eating Disorders for all clinicians involved with participants.”

In a separate statement, the Australia & New Zealand Academy for Eating Disorders in material part stated:

“The risks of developing an eating disorder were reportedly deemed to be justified on the basis of likely benefits of the trial and the inclusion of a risk management plan that would minimise risks and communicate risks associated with potential eating disorder development to participants and their parents/guardians. ANZAED is highly concerned about this justification. Eating disorders have the highest mortality rate of any mental illness, with onset common during adolescence. With consideration of these points, it is ANZAED’s position that the risk of developing an eating disorder is not warranted in this or any other research trial. …

As a result of careful consideration of the points raised above, ANZAED does not support this trial of an extremely low calorie weight loss intervention in adolescents.”

A petition condemning the study and demanding that it be stopped has now reached over 16,000 signatures worldwide and continues to increase every day.

Last week, doctors, counselors and advocates drafted and submitted a collaborative ethics complaint to the study. A copy of this report is attached at the end of this article. Some of the more significant statements include:

“Because the trial places participants in a prolonged state of calorie restriction, the risk of bulimic episodes is considerably heightened. Calorie restriction is a known primary trigger for hyperphagia (often termed binge eating), and is often accompanied by purging. The “Fast Track” trial induces participants to behave in a way that mimics Anorexia Nervosa (AN) (severe restriction of calories), placing them in considerable risk of going on to develop AN, Bulimia Nervosa (hyperphagia with or without purging), or Binge Eating Disorder (hyperphagia).”

“There is abundant evidence that bulimic episodes carry with them an immediate risk of death due to electrolyte imbalance and its impact on a variety of bodily systems if left untreated. Other risks associated with bulimic episodes include refeeding syndrome, cardiac failure, kidney failure, haemorrhage, dental erosion, hernia, compromised pulmonary function, impaired reproduction.”

“Although the research proposal suggests that the risk of bulimic episodes is secondary, and not warranting disclosure of risk to participants and their guardians, there has been no consideration given to the increase in the likelihood of such episodes stemming from both the premise of the study itself, and also the deliberate placement of the participants in a calorie deficit that falls within the category of “clinical starvation.”

“Dieting at any level has been termed the “most important predictor of eating disorders.” It has also been identified as “a risk factor for both obesity and eating disorders.”

“Extreme calorie restriction causes bone density loss, with many studies of starvation and the bone metabolism in laboratory animal models and humans finding evidence of either developmental delays, stunted bone growth, decreased bone mineral density or decreased cortical strength.”

“Given that weight loss is generally maximal at 6-12 months, the results of the “Fast Track to Health” trial run the risk of being skewed, because the subjects would not be followed for the length of time necessary to ascertain long term sustainable change.”

“There is compelling evidence that the “Fast Track to Health’ trial is incapable of achieving its express goal of “reducing weight and improving risk factors for heart disease and diabetes”, given that weight loss is not sustainable, with a 97% rate of regain. Calorie restriction can cause prolonged psychological distress, which in itself has been identified as a contributing factor to a number of physiological conditions, including cardiovascular disease, T2D, and metabolic syndrome because of the mechanisms involved in cyclic loss and gain.”

“Added to this established evidence that dieting in adolescence can trigger the onset of an eating disorder, including AN, BN, BED and OSFED. Even if the person does not acquire an eating disorder, they are at a considerably heightened risk of entering into cyclic weight loss and gain, which carries already mentioned health risks, including bone density loss.”

This is the second ethical complaint regarding the study.

The aforementioned Louise Adams appeared on radio station ABC Melbourne to bring public awareness to this ill-advised study.

The advocacy group, Eating Disorders Families Australia released a statement condemning the study and requesting that it be stopped.

HAES Australia endorsed the Complaint, condemned the study and issued its statement.

And then, the Academy for Eating Disorders, the world’s largest eating disorder organization issued its statement. This statement includes the following language: “Ultimately, the AED Board of Directors concluded that there is merit to many of the concerns raised. In particular it is critical to judge the likely benefits of any proposed research against its risk of harm and in this case, we are not convinced that the prospects of benefits sufficiently offsets the risks. We agreed that the AED will compose a position statement about the importance of fully considering the risk of increasing eating disorders and related problems alongside the gravity of this risk for the individuals put in harm’s way. When children or adolescents are the ones affected, the stakes are particularly high.”

To support their brethren and colleagues “Down Under,” organizations in the United States rallied to the cause. The international parent organization F.E.A.S.T., under the leadership of Laura Collins Lyster-Mench, has been speaking out against the study since it came to light in the latter part of 2018. The Eating Disorder Coalition condemned the study. Chevese Underhill Turner, Founder of the Binge Eating Disorder Association (“BEDA”) which recently merged with NEDA, stated: “There is no way to make a very low calorie diet and intermittent fasting trial safe for children. The risk clearly outweighs the benefit.” Doctors, dieticians and counselors to a person have uniformly questioned the efficacy of the study.

Other than the research doctors participating in the study, it appears as if the eating disorder industry has risen as one and not only condemned the study, but are taking proactive steps to attempt to stop the study … before even one child can be hurt by the hubris and egomaniacal needs of the research doctors.

Ms. Turner also stated, “We must also get past not speaking up because we are worried about offending colleagues. This can be done respectfully. Good people make poor decisions in research at times —they are human and have biases and blind spots like we all do. Protecting those biases and blind spots does not help anyone.”

Up to this point, the opposition to this study has been collegial and respectful. The opposition has been organized and scholarly. The legion of information establishing the extreme risks of this study has been provided in a professional manner. As such, the researchers can no longer claim “a blind spot.” The extreme risks have been disclosed by medical professionals, counselors and interested persons who have decades of experience. The researchers must know that this study will never be duplicated anywhere else in the world because of the risks. And if the doctors and medical professionals insist on proceeding with the study regardless of this overwhelming information, then surely, the gloves must come off.

Imagine a parent of one of the children in this study. Imagine not being informed of all of the possible risks. And your child is one of the children who develops an eating disorder. The frantic trips to the emergency room. Repeated blood tests showing irregularities in potassium, magnesium, and blood sugar. Perhaps a heart valve starts to leak. Seizures. And you find yourself in the fight for your child’s life. Fear becomes an every day, every minute visitor in your household. And then you discover that the doctors and professionals in this study had actual knowledge of these risks … and did not disclose all of these risks to you. The disbelief you would feel. The rage.

And so, dear doctors and other professionals conducting this study … proceed with the study … at your professional peril. But know that when you do, you too have risks. If and when the study does not produce any duplicable, tangible results. If and when a number of children in this study develop eating disorders. If and when you read the numerous complaints and studies opposing your studies. If and when you realize that the world eating disorder community has united as one condemning your study … and yet, you elected to proceed.

You will be alone. You very well may have blood on your hands. You will be a worldwide pariah. Your career may very well be over. But, that is ok. You can always find employment as a short order cook in a fast food restaurant serving up double cheeseburgers while you pontificate on how starvation diets actually do work.

But regardless, thank you. Thank you for uniting the eating disorder community and industry. Thank you for providing the platform by which one, strong unified voice was heard.

You may very well have discovered the formula by which collaboration and concerted efforts can come together to provide the basis upon which new breakthroughs are possible. Proving that even the Village Idiot can serve a useful purpose.

Ethics Complaint

“The Devil’s agents may be of flesh and blood may they not?”

     Sir Arthur Conan Doyle, The Hound of the Baskervilles

Many people in the eating disorder community profess to know, hope, believe, or want to believe that the insurance industry as a whole does not work against the best interests of their insured and medical providers and are not primarily concerned with their financial self-interest. And then, we encounter a person, an event or conduct that seems so implausible and so outrageous, that when proven true, has the ability to shake our belief to its very core.

On February 6, 2019, a lawsuit entitled Avalon Hills Health Care, Inc. vs. United Health Group, Inc, et al was removed from a state court in Utah to the United States District Court for the District of Utah. It was assigned cause number 1:19-cv-00009. The plaintiff’s allegations, if and when proven true, have the potential to shake the foundations of the manner in which insurance providers evaluate claims. At the same time, it could also pull back the curtain that hides the abuse of discretion and power held by peer review doctors employed by those insurance providers.

The lawsuit alleges that on behalf of a number of patients, Avalon Hills entered into single case agreements with United Behavioral Healthcare a/k/a Optum (“Optum”) so that Avalon Hills could render eating disorder treatment to its patients. In those single case agreements, Optum agreed to make payment for treatment rendered by Avalon Hills. Then, in April 2018, Optum sent a notice to Avalon Hills advising that payment for treatment for all patients under which a single case agreement was in place was being immediately stopped. [and contrary to the 30 day requirement in the single case agreements.] Despite having a long satisfactory relationship with Avalon Hills, Optum claimed that Avalon Hills was not providing medical oversight in accordance with Optum’s Level of Care Guidelines. [Curiously, Optum’s Guidelines do not include the DSM-V guidelines]

If that were the end of the dispute, the lawsuit would fall into that category of not atypical disputes between a medical treatment provider and insurance provider. It would have an impact upon the parties to the lawsuit but not much significance to the industry as a whole. But, that is not the end of the story. Far from it.

The lawsuit also alleges that Optum’s employees and contractors, including Dr. Randall Solomon who is based in the San Francisco Bay area began to contact the patients at Avalon Hills, and/or the parents or agents of the patients at Avalon Hills and advised them that payment was being immediately stopped and that no long term payments would be made. Optum’s employees allegedly also advised the patients that they should transfer to other facilities, most all of which had in-network contracts with Optum. These employees also told the patients or their families that Avalon Hills was not licensed to provide care and services. According to the lawsuit, the employees also stated that staff members at Avalon Hills abused patients!

The lawsuit alleges that Dr. Solomon, who was employed as an Associate Medical Director by Optum Health from January 2014 through February 2016 in the San Francisco Bay Area, [and subsequent thereto, has been used by Optum in peer-to-peer reviews] “… told insureds or their family members or agents that the Plaintiff [Avalon Hills] has used physical restraints on patients and forcibly injected them with sedatives. Specifically, Dr. Solomon told patient A.H.’s parents that A.H. had been restrained and injected against her will.” [emphasis added]

Dr. Solomon was not yet finished. According to the lawsuit, he also filed a complaint against Avalon Hills with the Utah Department of Health alleging that Avalon Hills had physically restrained and injected patients. As a result, the Utah Department of Health conducted an investigation into Avalon Hills. Its finding? It determined that Dr. Solomon’s claims were without merit.

These statements on the surface appear to be so grossly outrageous that they beggar belief. And yet, Dr. Solomon’s complaint to the Department of Health and its subsequent rejection exist. The lawsuit is pending in federal court and is a matter of public record.

And so surely, we must examine the motivations of each party. With regard to Avalon Hills, if their allegations are not true, then making such allegations in a public forum can only be looked upon as a “Hail Mary.” It would be a desperate attempt to extort Optum into making a large financial settlement in order to stay in business. This would undoubtedly be brought to light and would constitute the death knell for Avalon Hills. But, with eating disorder admissions in hospitals and treatment centers on the rise, and with Avalon Hills having a consistent patient census, that scenario seems very unlikely. Further, if the allegations of the complaint are true, then the motivation for Avalon Hills is clearly to step to the plate, to stand behind its practices and principles, to not back down and to show not just Optum, but the entire eating disorder industry that it believes in its program and will defend it.

Before exploring the motivations of Optum and Dr. Solomon, we must first question the peer review process used by Optum. First, Optum as the insurance provider has the absolute duty of good faith and fair dealing with the patient, its insured. To this end, an insurance company must investigate a claim expeditiously and reasonably and must not unduly delay in making a payment decision and rendering payment. It may also not deny a claim when there is no reasonable basis.

The peer review process is supposed to be objective. The insurance company should utilize independent outside third party doctors with experience in the medical treatments at issue. The peer review doctor is supposed to carefully review the medical records of the patient. With objectivity as the goal and with the requirement of good faith to the insured, why then is Optum employing a former employee, an associate medical director as a peer review doctor almost immediately after he left their employment? A doctor who was employed by OptumHealth in 2016. And as soon as  2017, he was the “outside” medical reviewer employed by Optum on Avalon Hills patients. Isn’t that is the very definition of the appearance of impropriety? At the same time, Dr. Solomon lists himself as a forensic psychiatrist and that his “… legal and forensic work covers a broad range of issues …” [In the practice of law, we call those persons, witnesses for hire.] In any event, it would appear as if Dr. Solomon merely went from being a paid employee of Optum to a paid “consultant” employed by Optum.

Dr. Solomon presumably has a contract with Optum. This contract involves reviewing claims being processed by Optum. Pursuant to this contract, Dr. Solomon is being paid to provide this service. Like all insurance companies, Optum is in the business of making a profit. One would be justified in wondering if Dr. Solomon, as a hired gun, did not consistently side with Optum and instead, sided with the treating medical professional and recommended payment for additional treatment, whether his contract with Optum would be renewed. The reality is that the more times Dr. Solomon sides with Optum and against the treating medical professional, the more money Optum saves and meanwhile, Optum maintains a façade of plausible deniability.

According to the lawsuit, six (6) patients were identified by their initials. In general, the cost of residential treatment is approximately $30,000 per month. The lawsuit alleges that each of these patients was contacted by employees of Optum and/or Dr. Solomon and the statements above were made to them. One can readily infer that the statements were obviously made with the intent of inducing them to leave Avalon Hills. If the patients had left, Avalon Hills would have incurred a potential loss of approximately $180,000 per month. And Optum would have financially benefitted since if the patients had gone to Optum’s in-network treatment providers, the financial exposure for Optum would be less perhaps substantially so.

Large financial exposure. Possible libel and slander. A medical career of not only a treatment center, but a psychiatrist at stake. And patients, our loved ones suffering from this disease, being treated as pawns by Optum.

If all allegations are proven to be true at trial, the ramifications of this alleged gross, outrageous conduct will echo through the eating disorder industry and insurance peer doctor review business. And the very words which constitute the bedrock of a physician’s practice … Primum non nocere … “first do no harm” will be sorely tested.

The National Health and Medical Research Council in Sydney Australia is underwriting and conducting a study known as “The Fast Track to Health.” This twelve (12) month study will be performed on guinea pigs … uh, children from the ages of 13 years to 17 years of age.

The Fast Track website states, “This is a research study for young people well above a healthy weight.”

This Study requires the children to follow extreme calorie restriction diets (800 calories per day) for one month. This will then be followed by 12 months of low calorie dieting for half the participants, and alternate day fasting for the other half. Children in the fasting group would eat just 600–700 calories a day for three days a week, approximately 25–35 per cent of estimated daily energy needs. The remaining four days would be a standard diet.

According to the website of the $1.2 million dollar study, the study’s aim is to “determine if MADF [Modified Alternate Day Fasting] is effective, safe and acceptable to adolescents compared to a standard weight control diet”.

In a co-signed letter to the Human Research Ethics Committee (HREC) at Sydney Children’s Hospitals, 29 health experts from Australia and the United States expressed concern that MADF is not safe nor effective for children. These experts are demanding that the study be abandoned claiming it poses unacceptable risks to children’s health.

In responding to the complaints, Ms. Asra Gholami, executive officer of research ethics at Sydney Children’s Hospitals Network, wrote: “The HREC recognises that there is a risk for a young person to develop an eating disorder with exposure to restrictive diets, and in particular very restrictive diets. Although these risks appear to be lower in medically supervised dieting programs, they will still be present.”

Ms. Gholami then digs her grave even deeper by stating that the risk of children developing an eating disorder is justified because of the potential for the participants to lose weight.

The Fast Track study researchers also acknowledge previous fasting diet studies did not produce long-term weight loss results.

The final nail in this ill-advised coffin is despite the fact that HREC is acknowledging the risks and limitations of the study in correspondence with health professionals, this information is not being given to the parents when signing their child up for the study.

To summarize, it would appear as if the researchers acknowledge the risk that some of their guinea pigs will develop an eating disorder as a result of this trial; that previous studies did not produce long-term weight loss results, and; they are not going to make complete disclosure of the risks and limitations to the parents of the guinea pigs.

It would appear as if the HREC’s position is that they are going to take children who mainstream society would consider obese, children who already may be very emotionally vulnerable and at high risk, and subject them to conditions which could, and in all reasonable medical probability, will result in some of them developing an eating disorder, a disease that we know has the highest mortality rate amongst all mental illnesses.

One can also speculate that if even one of these children dies as a direct result of developing and then succumbing to an eating disorder is that too high of a price to pay for some subjective results from this study? Are two children too many? What is the price in blood that would need to be paid for a study that in all reasonable likelihood, cannot be duplicated outside of the alleged “strict parameters” the HREC is implementing?

Past recent articles have focused on the Health at Any Size Movement. Chevese Turner is the Founder, President and CEO of the Binge Eating Disorder Association (“BEDA”) which has merged with the National Eating Disorder Association. I respect Mr. Turner very much for amongst other reasons she is a champion of the Health at Any Size Movement. She has commented and educated with passion and resolve. Amongst other statements, she said, “Many people don’t talk about it or speak up when HAES is challenged because the research community can be pretty condescending about their views and shut clinicians down. For this reason, a smaller group of HAES aligned clinicians and advocates have been speaking out and “disrupting”. We’re tired of being misinterpreted and condescended. We’re also tired of the harm being done to fat folx with EDs. At some point people have to stand up, but this is not received well within current power structures.”

And if ever there was a time for the HREC researchers to stand up and listen to champions like Ms. Turner, the time is at hand. Yes, 29 professionals have objected to this misguided study. But, that is not enough. More pressure needs to be brought to bear.

We know that the Academy for Eating Disorders (“AED”) is holding its International Conference in Sydney, Australia in June 2020. Eating disorders scientists, research doctors and clinicians will be flying into Sydney from all parts of the globe. The economic boon to Sydney and Australia will undoubtedly be well over $1,200,000, the cost of the study. If AED was not even approached about the HREC study and is not yet one of the 29 experts who have complained about this study, imagine the impact were AED to rise up as one and submit its concerns to HREC.

In 2014, The Royal Australian and New Zealand College of Psychiatrists issued some comprehensive clinical practice guidelines for treating eating disorders. I failed to locate that portion of that study indicating that starving your patients though a grossly restrictive diet was an effective and recommended clinical practice. Certainly, if the RANZCP has not yet responded with the strongest rebuke possible since this ill-advised study goes against the very substance of the 2014 clinical study, it needs to take that action.

In 2019, it is incredible to believe that any competent medical practitioner would endorse starvation through diet as an effective means to battle what society regards as “obesity.” The HREC’s anachronistic view on eating disorders and starvation diets is tantamount to using leeches, bloodletting and implanting goat testicles as mainstream medical treatment.

Otherwise, what can be done? Joan Riederer, the founder of the “Sock It To Ed Foundation,” in honor of her beloved daughter Erin Riederer, posted a petition on its Facebook page to let your voices be heard. That link is set forth below.

A starvation diet for our children to battle obesity. Acknowledging that the diet could result in the development of eating disorders. And, not making full disclosure to parents. Should even one beloved child die as a result, the ramifications could be much worse than just civil litigation. If you choose to gamble with a child’s life by exposing them to a known risk which could result in their death, the criminal justice system awaits you … and deservedly so.

Joan’s petition …

https://www.change.org/p/dr-michael-bryden-say-no-to-starving-our-teens-stop-the-fast-track-trial-1d356ed5-e8d5-48dc-b168-7710fcf062a4?recruiter=10064404&utm_source=share_petition&utm_medium=facebook&utm_campaign=psf_combo_share_initial.pacific_post_sap_share_gmail_abi.gmail_abi&utm_term=psf_combo_share_initial.pacific_post_sap_share_gmail_abi.gmail_abi&recruited_by_id=d70339f0-2f8d-0130-a65a-3c764e049c64&utm_content=fht-14288926-en-au%3Av6&fbclid=IwAR2ZNicfQ3UfUJ8FX14JFYwewgLALDgTkMKCS302XwIuuAzH89RMJ4O-5wU

On our journey through life, we encounter numerous crossroads. Choices and decisions are laid before us. Or sometimes they are made for us. At times, we may even find ourselves feeling as if we are being inexorably guided by some intangible, incorporeal feeling or sensory perception. Sometimes we look back upon the outcome or consequences of such decisions and are left wondering how we got to a certain place. This is particularly true in matters involving our health and the health of our loved ones.

I do not often write of my own personal experiences because quite frankly, my life is fairly mundane and of no particular interest. And yet, at times I sense that I am a conduit for far more important, more grand issues and messages. The Power of the Message. Not the Image of the Messenger. And yet, a recent event has made me again question whether we end up at various places in our life due to … Fate? Coincidence? Luck? Or…is there something greater at play?

On Super Bowl Sunday, I got a call from my 88-year-old father. My dad is a former air force pilot, was raised in the Midwest with that generation of men who didn’t show much emotion. He was the single breadwinner in the family. So, when he called saying he was in extreme pain in his abdominal region, I took notice. We ended up in the Emergency Room at Presbyterian Hospital in Dallas. This is the hospital in which my daughter, Morgan breathed her last in October 2016. And every time I have had to go to that hospital after that dark night, this sense of cold foreboding has gripped me.

The following day I received the news that my dad had gallstones which blocked the flow of bile. This was causing the severe pain. On Tuesday, the medical professionals inserted a tube down his throat to remove the gallstones. That procedure went well. However, discrepancies were found which resulted in the decision to remove his gall bladder the following day.

So too, the gall bladder removal surgery was successful. The attending doctors stated that surgery went off smoothly and he was being released the next day, that being Thursday. I picked him up from the hospital about 1:00 o’clock p.m. He was in good spirits and relatively pain free. I thought, “Not bad for an 88 year old man!” Two hours later those thoughts were ripped from my heart.

The attending doctor called me and asked me to bring my father in to see him the very next day. He advised that the pathologist had found a cancerous tumor in the gall bladder. He also said that the pathologist happened to be a friend of his and for no particular reason, had focused on the report of my dad. Instead of 2 to 3 days, the call came within 1 day.

We met with the doctor on Friday. He explained that because the cancer had been found at such an early stage, it had not yet spread throughout the liver and removal surgery was a viable option. But, he also advised that about 5 days after surgery, scar tissue begins to form and surgery would be more problematic. He also advised that although fewer than 20,000 people in the United States get gall bladder cancer every year, it is one of the most aggressive cancers and if not treated immediately, in all likelihood, he had fewer than 6 months of life remaining.

On Monday, February 11, 2019, the doctors operated and removed the cancerous part of the liver wall. Their post surgery report was glowing. They believed they got all of it but we are waiting on the pathology report … again.

As I sat with my father in ICU, I was very aware that his room was just two floors below the ICU room where my beloved daughter breathed her last just two years before. The rooms looked largely identical. The beeping of the medical equipment. The attention from the medical staff. The pain and anguish from that dark October night began once again, to wash over me. And then, through the grief, perhaps clarity began to happen.

But for the gallstones lodging in his bile duct in a certain exact way, he would not have had the severe pain. Without the severe pain, we would not have known of his gall bladder issue for several more months. Those several additional months would have resulted in the rapid spread of the cancer and my dad’s almost certain death in 2019. Had the gall bladder not been removed, and the pathologist not been a friend of the surgeon and for some unknown reason, been drawn to immediately review my dad’s test results, additional time would have elapsed and scar tissue would have begun to form and again, the cancer would have had additional time to spread.

As I sat in that ICU room, all of those “coincidences” became so clear. And a sense of peace came to me. An unexpected peace which shone through the fear and exhaustion and in the most unlikely of places.

Were all of those circumstances merely a chain of coincidences inextricably linked together? Was it fate? Could it have been blind dumb luck? Or, in our lifetimes, lifetimes that are far too short for many, is there really any way to begin to grasp the vast expanse and power of some incredible energy, life force or Divinity far greater than our meager existence?

Faith for the most part is not included as an important consideration in programs offered by most eating disorder centers, hospitals and professionals. There are no “evidence-based” studies indicating the effectiveness of faith in eating disorder programs. You cannot see faith. You cannot test faith. In fact, faith by its very essence is not based upon demonstrable facts. It stands upon its own. And sometimes, when all else fails, faith comes to us in our hour of need and it strengthens us.

For our loved ones suffering from eating disorders, sometimes, when our prescription drugs have failed, when tube feeding has failed, when our loved ones are in the darkest pit of despair…. sometimes faith comes to them.

And for those who have had one beloved life unfairly and prematurely ripped away, and one beloved life saved through the most improbable of circumstances … sometimes, faith becomes a lifeline.

P.S. On Wednesday, February 13, the pathology report came back. The doctors were able to remove all of the cancer cells. There is no lingering or residual cancer, no chemo is necessary and he is expected home by Sunday. Luck? Skilled surgeons? Guardian Angel? Whichever may be the case, gratitude

Recently, we addressed the Health at Every Size (“HAES”) movement which has, over time developed in the eating disorder community. We postulated that the HAES movement was at best lightly regarded if not outright disregarded and/or unknown by mainstream society and was in fact, in some ways, a detriment hurting the eating disorder community.

We noted that the HAES movement at its core is about fairness and equality. It is about casting off the shackles of prejudice of a society that wrongly places value on the model thin body. It is about non-acceptance of a person. It is about stereotyping a person because of how they look. It is about speaking out against the degradation of a person because they are different. It is about casting aside mainstream views of a person based upon incorrect and faulty information.

We concluded that the HAES movement does not belong in the eating disorder industry and community. That in many ways, HAES and eating disorders are only loosely connected. We theorized that the HAES movement is not an eating disorders issue but instead is a civil rights movement.

And in support of those musings, we can now present you some evidentiary exhibits. From Wednesday, February 6, 2019 through Sunday, February 10, 2019, the international association of eating disorders professionals (“iaedp”) will be meeting on the frozen tundra of Palm Springs, California. This five (5) day international conference will bring together some of the most well known clinicians and treating doctors in the eating disorder industry.

The topics to be discussed will be many and varied. They include “dysfunctional passion” and psychodrama. Dissociative identity disorder and “healing emphasis yoga.” Exercise in the treatment of eating disorders and body image disturbance. Implementing LBGTQ+ Inclusive and Gender Affirming Programming and Nutrition therapy. Sessions in Spanish language. Intuitive eating and military service. Recovery from shame, weight restoration and shame. A clinician’s guide to coping with the suicide of a patient. Atypical anorexia, Family Based Therapy and Cognitive Behavioral Therapy. Evidence-based Therapy. Body Dysmorphic Disorder and integrating telehealth interventions. Utilizing laughter in therapy and treating athletes with eating disorders. Inspiration and joy in the recovery process and even … veganism. This wide cornucopia of topics seemingly covers every possible topic in the eating disorder community and industry. Seemingly all topics save one.

In the five (5) days of meetings, there is not one mention of the Health at Every Size movement. There is not one mention of treating what mainstream society would regard as the obese patient. There is not one mention of topics such as weight stigma, fat shaming, the manner in which BMI has come under attack, the prevalence of binge eating disorder or legislative advances on behalf of the HAES movement. Starting at 8:30 o’clock a.m. on Wednesday and concluding at 12:30 o’clock p.m. on Sunday, not one minute was specifically spared for HAES.

To be fair, perhaps this was an anomaly. So, research was undertaken into the 2018 iaedp Symposium. In the five (5) days of the 2018 Conference, we discovered no time set aside for HAES although there was one (1) session on “Weight Stigma in Eating Disorder Treatment Settings: A Discussion on Identification & Reduction.”

At the 2017 iaedp Symposium, again there was no mention of HAES. (Although discredited and disreputable psychologist Mark Schwartz did present a session on “Eating Disorders, Sexuality and Intimacy.” One can’t help but wonder if he utilized his penchant for brainwashing,  hypnosis and concocted memories as set forth in four lawsuits against him during that session. And yet, I digress.)

Perhaps the omission of HAES should come as no surprise. In 2015, the National Institute of Health published a comprehensive study entitled, “Impact of weight bias and stigma on quality of care and outcomes for patients with obesity.” As stated in the study, “The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity.” Amongst the findings and conclusions, the study included the following statements:

– Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making.

– Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care

– Obesity is a commonly and strongly stigmatized characteristic. There is substantial empirical evidence that people with obesity elicit negative feelings such as disgust, anger, blame and dislike in others

– Furthermore, there is a growing body of evidence that physicians and other healthcare professionals hold strong negative opinions about people with obesity

– Primary care providers, medical trainees, nurses and other healthcare professionals hold explicit as well as implicit negative opinions about people with obesity.

– The combination of implicit and explicit negative obesity attitudes may elevate the potential for impaired patient-centred communication, which is associated with a 19% higher risk of patient non-adherence, as well as mistrust, and worse patient weight loss, recovery and mental health outcomes.

– Finally, physicians may over-attribute symptoms and problems to obesity, and fail to refer the patient for diagnostic testing or to consider treatment options beyond advising the patient to lose weight. In one study involving medical students, virtual patients with shortness of breath were more likely to receive lifestyle change recommendations if they were obese (54% vs. 13%), and more likely to receive medication to manage symptoms if they were normal weight (23% vs. 5%).

A link to the study is included below[1].

With such a damning study, as well as other similar studies readily available online, one should assume that if the eating disorder industry was serious about being “all inclusive,” it would be embracing the HAES movement and including this vitally important information as educational enrichment for its members every year. This would be especially true since binge eating disorder is the most common eating disorder. And yet, iaedp at its conference is as silent as the tomb on these issues this year.

Perhaps the eating disorder industry is supportive in other venues. This year, the 7^th Annual International Weight Stigma Conference is being held in Toronto, Canada in June (thank you to Chevese Turner for that information). And investigation into the sponsors of this event the previous year reveals the following sponsors: Frontiers [an open science platform]; Leeds Beckett University; Friend of Marilyn [social media advocate]; Wiley Publishing; Pearlsong Press; ASDAH; NAAFA [non-profit human rights organization]; Routledge Journals; SPSSI [international group of scientists and psychologists].

There is no Residential Eating Disorder Consortium (“REDC”). There is no ED Coalition. There is no National Eating Disorder Association. (“NEDA”) There are no United States treatment centers. There are no private equity firms. There are no eating disorder related foundations or United States organizations. No sponsorships at all. No investment of time. No investment of money.

The ED Coalition is charged with representing the eating disorder community on Capitol Hill. Thorough research enables you to discover the identity of the lobbyist utilized by the ED Coalition, the REDC and NEDA. Paid lobbyists are required to file quarterly reports which sets forth the amounts they are paid, the bills upon which they are lobbying and the specific portions, if any, of those bills. A review of the bills being pursued by the lobbyist utilized by these organizations indicate lobbying on bills impacting additional education for primary care givers and doctors, allowing Tricare coverage of eating disorders to stand alone treatment centers and requiring insurance companies to specifically include residential treatment centers under parity laws in insurance policies. (Although arguably, the Mental Health Parity Act and Affordable Care Act should have taken care of that issue.) There is no mention at all of HAES or the Health at Every Size movement.

In the prior article, I opined that the HAES movement is much more of a social justice movement, an ipso facto civil rights movement. It involves perceptions, discrimination and disparate treatment of HAES. That it is only loosely connected to the eating disorder industry. And understandably, there was respectful disagreement and intelligent discourse on that topic. But now, there is concrete evidence of the manner in which the eating disorder industry treats the HAES movement through its conduct and omissions backed by a research study.

When the biological genesis of certain types of “obesity” is revealed and disclosed, then there will be lawsuits filed on behalf of those who are discriminated against, stigmatized, ignored and mocked. For sometimes this reprehensible conduct manifests itself openly and notoriously. However, most times, the misconduct is far more subtle … existing in the shadows along with the disease itself.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381543/

Let’s address the Health at Every Size (“HAES”) movement which has, over time developed in the eating disorder community. At the same time, let us also give a forum to the many whispers and voices behind the scenes about which I and many others have heard. And maybe at the end, let’s propose a radical, bold direction for HAES.

After listening to a number of people with experience in the eating disorder industry, the message which keeps being delivered is … The HAES movement is at best lightly regarded if not outright disregarded and/or unknown by mainstream society and is in fact, in some ways, a detriment that is hurting the eating disorder community.

Now in reading up to this point, some people may have spewed coffee over their computer screen, cursed me and every living and dead relative I have, employed the nearest hit man or have already dismissed the message in this missive. But, nonetheless, let’s continue.

If there is any merit behind these messages, the issues presented could be addressed simply by rebranding or something even more radical. This could bring greater credibility and accessibility to its cause. But even that might not be enough.

On the HAES community website, haescommunity.com, the following language appears,

“RESPECT … Honors differences in size, age, race, ethnicity, gender, dis/ability, sexual orientation, religion, class, and other human attributes.”

“CRITICAL AWARENESS … Challenges scientific and cultural assumptions.”

This website then states, “It supports people of all sizes in addressing health directly by adopting healthy behaviors. It is an inclusive movement, recognizing that our social characteristics, such as our size, race, national origin, sexuality, gender, disability status, and other attributes, are assets, and acknowledges and challenges the structural and systemic forces that impinge on living well.”

On the website for the Association for Size Diversity and Health (“ASDAH”), with regard the HAES Principles and Approach it states:

The Association for Size Diversity and Health (ASDAH) affirms a holistic definition of health, which cannot be characterized as simply the absence of physical or mental illness, limitation, or disease. Rather, health exists on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living. Pursuing health is neither a moral imperative nor an individual obligation, and health status should never be used to judge, oppress, or determine the value of an individual.

In reading these principles, vision and mission, one can understandably question whether they are reading a mission statement of a political party, a website advertisement for a new yoga/meditation regiment, a follow up outreach contact from a doctor or clinician … or a statement of principles from a social justice movement.

We do know people are not biologically healthy at “every size.” To hold counter to this scientific fact is tantamount to shaking one’s fist at the clouds. Any competent doctor is going to tell you that excess body weight is a risk factor for most major, chronic diseases. The connection between excess weight and conditions like type 2 diabetes, sleep apnea, and arthritis has been scientifically demonstrated. Additional conditions are linked to obesity … heart disease and stroke, cancers of the colon, endometrial, kidney and esophagus. The risk of gall bladder disease or gallstones is increased. Osteoarthritis and gout are more common and linked to obesity. If the HAES movement regards these truisms as mere scientific “assumptions,” they are consciously choosing to ignore countless, objective scientific research studies conducted over a span of decades. And yet, it appears as if the HAES movement wishes to disregard these studies because they do not like the outcomes or their perceptions. If HAES continues to equate scientific research supporting the belief that excess weight is bad because it results in a much greater potential for serious physical health issues with it simply being a moral judgment about people’s bodies, then HAES is doing itself and its followers a tremendous disservice.

If a person does not believe the sun rises in the east and sets in the west, and trumpets this belief, this lack of credibility touches all other issues. And it does not have to be that way.

There are many issues raised by HAES which are legitimate and compelling. Many of HAES’s talking points are supported by the medical industry, clinicians, doctors and scientists. Attacking BMI and the definitions of “obesity” are near the top of these issues. There is no dispute that BMI is coming under greater attack from doctors, clinicians, and scientists. Recent studies indicate it is relatively poor at assessing chronic disease in either direction.

But, where HAES fails is with the realization that proponents of HAES tend to blur the distinction between weight not being the most important measure of health … to weight not being relevant at all to health. And that is a distinction with a difference. And perhaps that distinction is not only being lost but not propounded at all because of the reality that obese people are stigmatized and ostracized by mainstream society.

Review again statements made by HAES. “It is an inclusive movement, recognizing that our social characteristics, such as our size, race, national origin, sexuality, gender, disability status, and other attributes, are assets, and acknowledges and challenges the structural and systemic forces that impinge on living well.” The HAES movement also states, “Honors differences in size, age, race, ethnicity, gender, dis/ability, sexual orientation, religion, class, and other human attributes.”

If we review the first three core principles of HAES, we find the following:

1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
2. Health Enhancement:Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
3. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.

Look at the impactful words being utilized “…Accept and respect the inherent diversity of body shapes and sizes … equalize access to information and services … work to end weight discrimination.”

Now, let’s review goals and mission statements from other organizations. The American Civil Liberties Union (“ACLU”) states, “ … the ACLU has been our nation’s guardian of liberty, working in courts, legislatures, and communities to defend and preserve the individual rights and liberties that the Constitution and the laws of the United States guarantee everyone in this country.

Whether it’s achieving full equality for LGBT people, establishing new privacy protections for our digital age of widespread government surveillance, ending mass incarceration, or preserving the right to vote or the right to have an abortion, the ACLU takes up the toughest civil liberties cases and issues to defend all people …”

Let’s review the principle objectives of the National Association for the Advancement of Colored People (“NAACP”):

… the principal objectives of the Association shall be:

• To ensure the political, educational, social, and economic equality of all citizens
• To achieve equality of rights and eliminate race prejudice among the citizens of the United States
• To remove all barriers of racial discrimination through democratic processes
• To seek enactment and enforcement of federal, state, and local laws securing civil rights
• To inform the public of the adverse effects of racial discrimination and to seek its elimination
• To educate persons as to their constitutional rights and to take all lawful action to secure the exercise thereof, and to take any other lawful action in furtherance of these objectives, consistent with the NAACP’s Articles of Incorporation and this Constitution.

The impactful, powerful civil rights organizations like the ACLU, the NAACP, LULAC all have similar principles in common … equality of life, liberty and the pursuit of happiness free from discrimination and society’s prejudices and presuppositions. And who does that sound like? The HAES movement speaks of an all inclusive movement and acknowledging that “… social characteristics, such as our size, race, national origin, sexuality, gender, disability status, and other attributes, are assets, and acknowledges and challenges the structural and systemic forces that impinge on living well.”

The HAES movement at its core is about fairness and equality. It is about casting off the shackles of prejudice of a society that wrongly places value on the model thin body. It is about non-acceptance of a person. It is about stereotyping a person because of how they look. It is about degrading a person because they are different. It is about casting aside mainstream views of a person based upon incorrect and faulty information. How dare you judge me because of the color of my skin!!! uh wait … How dare you judge me because of my religious beliefs! uh wait … How dare you judge me because of my sexual orientation! … How dare you judge me because I am obese in society’s eyes.

The HAES movement does not belong in the eating disorder industry and community. The two HAES and eating disorders are in many ways, only loosely connected. And quite frankly, the eating disorder industry might not be a powerful enough platform (YET), to spread the message, mission and principles of the HAES movement.

The HAES movement is not at its heart, an eating disorders movement. The HAES movement is a civil rights movement. And perhaps the scientific assumptions from which the HAES movement tries to distance are the very fundamental core beliefs which could provide the foundation upon which the HAES movement could project itself into “a protected class” under the Constitution and laws of the United States.

At the start of this article, I made the statement that perhaps The HAES movement was a detriment hurting the eating disorder community. The equally impactful question should also be, is the eating disorder community and industry hurting the HAES movement?

If the HAES movement is truly a civil rights movement, if it is designed to address the wrongs and misdeeds being perpetrated by mainstream society, then it needs a dynamic, powerful independent voice to give meaning and substance to its message. And make no mistake, HAES has a powerful, substantive message to send. It just needs to find an effective platform and forum for that message.

(Thank you to the incredible Chevese Turner for the correction on the name of the movement… and her insights! Chevese, you are a warrior.)

Congratulations to the following new officers of the Eating Disorder Coalition:

President   — Chase Bannister, Bannister Consultancy

Vice President – Molly McShane, Monte Nido

Treasurer – Jillian Lampert, The Emily Program

Secretary – Millie Plotkin, The Eating Recovery Center

The immediate past-president is S. Bryn Austin, Academy for Eating Disorders.

For those of us who have suffered, paid the ultimate price, or who still suffer from eating disorders, let us hope that the new leadership recognizes the tremendous opportunities which lie before it … and the incredible challenges they face.

A federal district court judge in Texas ruled that The Affordable Care Act is unconstitutional. Congress is in disarray as both major parties look to perpetuate their own power over the needs of the country as a whole. Despite the Mental Health Parity Act being enacted 11 years ago, insurance providers routinely treat mental health claims differently. Investigations are being conducted by several state boards of psychology against both individual counselors and treatment centers.

Private equity firms have purchased most of the residential treatment programs. This has led to speculation by families, individuals and employees of those treatment centers that quality of care has deteriorated as financial demands escalate to meet the required debt structure. This concern has escalated with the realization that private equity firms are dictating the course of lobbying efforts in our nation’s capitol. In fact, of the four officers listed above, three are employees of the private equity firms Levine, Leichtman Capital Partners (Monte Nido); TT Capital Partners (The Emily Program) and CCMP Capital Advisors (ERC).

In the past two years, there have been several instances in which counselors in residential treatment programs sexually exploited patients in those programs.

The terms “chaos,” “Wild West,” “out-of-control” have all been used by numerous people to define the current state of the eating disorder industry.

And yet, from this chaos, from these many obstacles come incredible opportunities. Opportunities that are squarely before the new incoming president. Opportunities to collaborate. Opportunities to allow the voices of families to be heard anew. Opportunities to be much more inclusive. Opportunities to show, not through his words, but through his actions, that he will not be subservient to the demands of the wealthy, but will instead embrace the greater possibilities of a better tomorrow. Opportunities to espouse a vision shared by so many families, a vision of hope, a vision of renewed strength, a vision of faith, a vision of healing.

The eating disorder industry has reached a crossroads. Some believe it has not only reached, but also surpassed a tipping point. And many people believe that business as usual is not good enough.

But still, opportunities abound for the new president. Opportunities to show independent strength. Opportunities to be the voice for those whose voices have been ripped from life. Opportunities to be a leader for those who suffer from this disease.

Opportunities to demonstrate that it is about the Power of the Message and not the Image of the Messenger.

Mr. President, embrace those opportunities.

In November 2018, the Residential Eating Disorder Consortium (“REDC”) launched its Standards of Excellence Project (“STEP”). The REDC preliminarily explained STEP as, “ … a collection of works demonstrating REDC’s continued commitment to raising industry standards and professionalizing the field. STEP represents the strongest, clearest declaration yet of the patient-centered values, beliefs, and principles that guide REDC’s members in their work every day.”

First, I strongly believe the REDC members want to help people suffering from eating disorders. I believe that REDC members are professionals, learned in their fields and feel much of the same frustrations that the families afflicted by this disease feel. Within the confines of their current financial reality, where expansion and treatment protocol may be driven by private equity interests, they desire to embrace patient-centered values, beliefs and principles.

Further, it is no secret that I have been a frequent critic of some 0f the policies of the REDC. And yet, when they recognize that problems exist and attempt to address and rectify those problems, they should rightly be commended for attempting to update its standards and solve these problems.

Before addressing the new Code of Ethics, it is also worth noting that previously, a number of discrepancies and curiosities were brought to light regarding the REDC’s officers and Board of Directors. Although the REDC limits itself to those entities which provide residential treatment care as part of their offered services, there were a few officers and directors who were not employed by these entities. Whether this constituted an actual “issue” is subject to speculation. Regardless, the officers and directors of the REDC are now all employed by residential treatment providers. Perhaps a small issue but it was addressed. The REDC should be commended for that action.

Finally, questions should be raised as to whether the STEP program is meant merely as a series of internal guidelines designed to give their members a general blueprint to follow. Or is the STEP program designed to be an enforceable set of fundamental, exigent rules objectively applied and enforced for the greater good and relied upon by families and those who suffer from this disease.

If the former is the intent, at this point one can stop reading. A privately held company or organization can implement whatever guidelines it wishes within the scope and bounds of the law. It only has to face ramifications for implementing these non-enforceable guidelines without concrete consequences.

However, the remainder of this article and future ones addressing the STEP program are based on the premise that the REDC in good faith, intended to implement these rules as binding statements of governance upon which families and patients could rely.

Code of Ethics

In the preamble to the REDC Code of Ethics, the REDC states:

In 2018, REDC codified the principles in its Center of Excellence document into a Code of Ethics specifically for REDC member organizations. REDC’s members understand that just as they seek objective validation of other fields’ claims of high standards, their external stakeholders — members of the public, insurance companies, academics, regulators, and others — are more likely to trust them when they demonstrate a willingness to establish clear boundaries and practices. REDC’s Code of Ethics demonstrates that its members are governed by specific ethical principles.

Indeed, a valid statement of the minimum standards which should be demanded from those whom we entrust to help save the life of our loved ones. And yet, one statement stands out not so much for what it includes, but for what it does not specifically include. That language is as follows: “ … members of the public, insurance companies, academics, regulators, and others — are more likely to trust them when they demonstrate a willingness to establish clear boundaries and practices.” So, who is not specifically mentioned in this sentence … only the most important persons. The families. The parents. The patients. Those whom are entrusted to their care. Those people who are living in fear. Granted, the REDC undoubtedly intended that those incredibly important people were to be included in the abstract as part of the “public,” or “others.” But we are the people who make their existence an unfortunate necessity. We should be at the forefront of their consciousness. Now, was this a mere oversight? Perhaps. But it is a grievous oversight. Families should be placed first and at the forefront of those people who should be taken into consideration and protected and who should be able to rely upon clear boundaries and practices.

The Sections of the Code of Ethics

The Consortium’s Code of Ethics is broken down into nine different definitional sections and an Appendix. These sections are entitled as follows:

• REDC members accurately represent their treatment outcomes.
• REDC members accurately represent their range of services and the qualifications of their staff.
• REDC members offer patients clinical services that are grounded in a three-pronged approach: scientific evidence published in peer-reviewed journals; clinical expertise considered practice-based evidence; and patient values, preferences, and characteristics.
• REDC members only admit patients whose needs are appropriate for the type of treatment provided — and for the level of care provided — at their programs.
• In marketing their services, REDC members employ messaging that is truthful, fair, non-deceptive, capable of being substantiated, and in all respects lawful.
• REDC members do not pay or receive anything of value in exchange for patient business.
• Prior to admitting a patient, REDC members clearly communicate the cost of treatment that may be required in both the short term and the long term.
• REDC members disclose financial relationships and any potential conflicts of interest that might affect patient care.
• When participating in media interviews, REDC members are focused on educating the public and raising awareness about eating disorders.

A brief overview of each section follows to give a more complete picture.

(1).

REDC members accurately represent their treatment outcomes.

In this section, the following language is included: “REDC members accurately represent expected outcomes so that patients understand what they are “buying.” They do not exaggerate services or promise unrealistic outcomes. … Members must accurately represent measures, including providing details about sample sizes and response rates such that stakeholders can understand the degree to which reported outcomes represent a patient population.”

This section is crucially important for families. More often than not, parents are researching these facilities online. As they watch their loved one deteriorate physically, mentally, emotionally, fear and desperation grip them. There are precious few objective resources a family can rely upon in evaluating treatment facilities. There is no federal or state oversight as to what information is or should be included.

This has resulted in outlandish claims. For example, one REDC member currently represents on its website:  “99% of parents of child/adolescent patients report that treatment at Center X was helpful, and 97% would recommend Center X to other families in need of treatment.” There is no detail about sample size. There is no detail about response rate. I have yet to encounter any professional who believes those numbers. And yet, desperate families cling to the faintest hope.

Again, if the STEP program is designed merely to be general internal guidelines with no enforcement policies in place, so be it. Advice families of this limitation. If the STEP program represents a strong, enforceable vision for the future, what are its officers prepared to do to bring all members within compliance?

(2).

REDC members accurately represent their range of services and the qualifications of their staff.

In this section, the following language is included: “REDC members understand the limitations of their service offerings and never claim to treat certain conditions, including any co-occurring conditions, for which they are not qualified. All providers should have the appropriate education, training, and experience, and should limit their practice accordingly. Providers may practice up to the full scope of practice as defined by their license(s).”

This section is direct and to the point.

(3).

 REDC members offer patients clinical services that are grounded in a three-pronged approach: scientific evidence published in peer-reviewed journals; clinical expertise considered practice-based evidence; and patient values, preferences, and characteristics.

This section includes the following material language: “Treatment is grounded in the available research, while also focused on spurring innovations (e.g., from clinical practice, academic literature, and so forth). In addition, in keeping with The Joint Commission and CARF International standards, patient values, preferences, and characteristics are also taken into account, along with families’ perspectives. Taking patient preferences into account should not be construed as allowing patient preferences to override the clinical expertise/medical judgment of treatment providers.”

This subsection includes the most complex issues within the Code of Ethics. Every treatment center utilizes the phrase, “evidence-based treatment” within its treatment regiment. This is usually a reference to Cognitive Behavioral Therapy or Family Based Therapy being utilized at those centers. But, families are left to wonder the percentage of time during the week in which actual “evidence-based treatment” is being utilized and whether it is being utilized in the manner resembling the protocol in place during the testing/evaluation/analysis stages. Patient preferences are very difficult to measure, as one must have the necessary expertise to determine the times when the patient is talking. And when it is the disease talking through the patient.

Treatment and recovery are the very heart of the industry. Further, the use of the term “evidence-based” has become incredibly subjective and can be defined in so many different ways. And whereas the use of, “scientific evidence published in peer-reviewed journals” is one of the legs in the three-prong approach, even this is amorphous.

Clinical expertise, as demonstrated by a research study conducted by BYU and Emory University, is often colored by confirmation bias which can result in overestimation of the effectiveness of treatment protocols.

But, what are the options? Collaboration with university and academic researchers as mentioned by the REDC in this subsection is a good starting point. Being open to university based programs and working with organizations like the Academy for Eating Disorders are other progressive actions which can be undertaken.

(4).

 REDC members only admit patients whose needs are appropriate for the type of treatment provided — and for the level of care provided — at their programs.

This section states: “REDC members strictly adhere to guidelines from the American Psychiatric Association (APA) regarding the appropriate levels of care, and they are committed to treating at the most appropriate level of care required to meet a patient’s needs. If the program is not able to appropriately meet the clinical and medical needs of the patient, it guides the patient to more clinically and/or medically appropriate alternative treatment resources.”

This subsection in essence states that REDC members have accepted the DSM-V guidelines set forth by the APA and will strictly adhere to same. If this section is enforced as written and as obviously clearly intended, the families which come to you for assistance should feel a sense of relief. Objective guidelines and treatment parameters reduce the likelihood of confirmation bias and give a greatest awareness and transparency.

(5).

 In marketing their services, REDC members employ messaging that is truthful, fair, non-deceptive, capable of being substantiated, and in all respects lawful.

This section states in material part: “REDC members ensure that marketing messages communicate substantive, critical information about their therapeutic services — and are not simply an enticement to choose one facility over the competition. All express marketing claims must be substantiated or capable of substantiation with appropriate evidence when made.”

The remarks and concerns set forth in section 1 are applicable to this section. Often the first, substantive information about treatment centers is gleaned from reviewing the center’s website. A deeper dive may include employee sites like glassdoor.com, the groups on social media and parent advocacy groups like F.E.A.S.T.

The language utilized by the REDC in this subsection is effective, straightforward and substantive.

But, what is the REDC prepared to do in order to enforce that language? What investigative procedure do they have in place to review complaints from families? How far is the REDC prepared to go to stand behind these principles and if necessary, expel a member (and thereby lose revenue) if a rogue member refused to comply with those standards?

(6).

REDC members do not pay or receive anything of value in exchange for patient business.

This section contains some perplexing inconsistencies. For example, the section begins with the following language: “REDC members are committed to relying upon objective facts and open, honest communication — not financial enticements — as a way to engage stakeholders. REDC members do not offer financial incentives of any kind to patients, referral sources, or anyone else for the purpose of inducing (or rewarding) the referral of business.” [emphasis added]

But then, almost immediately thereafter, the following language appears:

“Travel: Reimbursement for travel, accommodations, and meals must be “reasonable.”

On the one hand, the REDC sets forth a standard that no financial incentives of any kind will be offered for the purpose of the referral of business. It then seemingly contradicts itself by reimbursing “reasonable” travel, accommodations, meals, gifts of $25 or less and production bonuses to W-2 employees.

The REDC then identifies that transportation scholarships and subsidies can be utilized but only sparingly.

It is not difficult to ascertain what the REDC is attempting to undertake in this subsection. It is attempting to establish an environment of open competition while providing direction to its member institutions as to what conduct is acceptable and that which is not. And yet in doing so, the families who would review this subsection could understandably be left confused.

Cleaning up the language in this subsection would not be painstakingly difficult and could provide clarity.

(7).

Prior to admitting a patient, REDC members clearly communicate the cost of treatment that may be required in both the short term and the long term.

The pertinent language of this subsection includes the following: “Treatment programs in our industry often must admit patients without full information about what payers will and will not cover. This lack of transparency in health-insurance reimbursement makes it difficult to predict the out-of-pocket burden on patients and their families. Despite this challenge, REDC members should do everything in their power to ensure that patients and families are as well-informed as possible about the cost of services and patients’ and families’ financial responsibility for those services, such that patients and families can make informed decisions about how that financial obligation is likely to affect them in both the short term and the long term. Prior to admitting patients, REDC members have honest conversations with patients and families about recidivism rates and the typical illness duration and course of care that may be required over a patient’s lifetime. REDC members accurately communicate regarding their prices, expectations about patient out-of pocket costs, and how long a patient is expected to require treatment.”

This language is clear, concise and arguably should be posted on the wall of the financial director’s office where the parents or patients will be meeting to make payments and to discuss financing of the treatment being provided. But, parents and patients also need to be advised of additional information. They need to be informed of the peer-to-peer process, the manner in which insurance entities process claims, that insurance entities can stop payment for treatment with 24 hours notice or less, that families may be forced to make immediate and often expensive travel plans to bring their loved ones home with little or no notice.

This type of information feeds into the requirement of, and necessity for discharge planning beginning the very first day of treatment. (As was cited in the 2012 AED Clinical Practice Recommendations.) With this additional information, families and patients will have a better understanding of possible unexpected costs and the financial pitfalls which could arise.

(8).

 REDC members disclose financial relationships and any potential conflicts of interest that might affect patient care.

The entirety of this subsection states: “REDC members alert patients about any internal or external relationships, financial or otherwise, that their programs have that might affect patient care. If a REDC member directs a patient from one program to another in which the member has a financial interest, patients should be informed of that fact. It is unethical for programs not to disclose to patients any relationships and/or financial incentive arrangements that might affect patient care. [See section 5, “Sound and Ethical Business Practices,” in the “Center of Excellence” document. Also see the “Marketing Best Practices” document.]” [emphasis added]

This section imposes on the REDC members a requirement of open and honest transparency. The issue then is to discern and define those relationships which “might affect patient care.”

In the past, several articles have brought to light the manner in which private equity firms have taken over the residential eating disorder treatment centers. The majority of the information has focused on the negative aspects of this type of ownership. No governmental oversight. No state regulatory oversight. Acquisition transactions kept secret. Treatment that results in greater reimbursement opportunities being pursued over treatment that may be more effective but result in lesser financial gains.

But there are certainly positive aspects. New financial resources directed toward treatment means more people receive treatment. Additional media outlets are informed of the deadly nature of this disease. Greater credibility and ability to bring financial weight to bear against insurance providers seeking to prematurely release patients because those insurance providers do not adhere to the DSM V or APA guidelines. These private ownership relationships are perceived to provide a more stable financial foundation in the present. As such, for reasons both good and bad, private equity ownership clearly and unequivocally, might affect patient care.

Therefore utilizing the REDC’s own wording and own criteria, the private equity ownership of these treatment centers might affect patient care, both in a positive way and negative manner. And yet, they are not disclosed to patients and families.

(9).

When participating in media interviews, REDC members are focused on educating the public and raising awareness about eating disorders.

This section states in material part: “REDC members embrace opportunities to participate in responsible and authoritative interviews aimed at educating audiences and raising awareness about eating disorders. Treatment programs have a solemn responsibility to be good citizens in all forms of media in which they participate.”

This is certainly an admirable statement and sets forth what should be the bare, minimum standards. But, in terms of “educating audiences,” does that also include informing families that there is a paucity of actual, evidence-based medicine in the world of eating disorders. That there is not a lot of medical professionals doing clinical trials with a large enough patient population. That the field of psychiatry has not developed to the point where it can reasonably assign empirical probabilities to different recovery outcomes.” Certainly, life skills, counseling and valuable treatment can be received at residential treatment programs and these programs in one way or another will be valued commodities in the eating disorder industry for the foreseeable future. But, as part of the educational process, certainly all options need to be presented even if in carefully vetted brief sound bites. Integrity of the message must predominate over financial gain.

Observations and Conclusions

Mental health in the United States has reached a crossroads. The Affordable Care Act is on life-support and in its current format, is not expected to survive. Business as usual cannot last.

The REDC is to commended for these steps. But, the question remains … is this merely a recitation of flexible, internal guidelines or is this intended to be the genesis of hard and fast rules upon which families and patients can rely? Is this the first map to a bold, new frontier where patients and families are placed first?

If so, implement procedures to enforce these guidelines. Turn these guidelines into rules. Empower families to interact with you at the highest levels. Give families a strong voice in the treatment process. Enforce these guidelines through administrative procedures and demand compliance from your members.

REDC, be the leaders you aspire to be. Do not just say the words. Undertake the actions openly, honestly, democratically. Through your actions, show you place your patients  and their families first. If you do these things, people will support and follow you. I know I will.

In writing of transparency, truth and integrity, I believe those traits must be demonstrated by all … even those who write of perceived inequities. And when mistakes or misinterpretations are made they should be owned and addressed.

After this article was published, a few trusted persons approached me and stated that the article contained facts which were incorrect. They pointed out the flaws and the manner in which the information in the article was incorrect and focused upon Jaffe Management’s innocent involvement. As a result, I conducted a deeper dive into the subjects of the article and discovered their viewpoints had merit. To the extent that any nefarious intent may have been directed toward Jaffe Management, that was not the intent of the article and should not be attributed to them. 

As a result, I believe that this clarification is necessary with apologies to those who were slighted in the article, believe they were being slighted in the article, or believe that nefarious motives were being assigned to them as a result.

In order that there is full disclosure, I will leave the article below in its entirety unedited.. But, the views expressed should be tempered by this clarification.

“PR is premised on truth, trust and transparency.”

            Richard Edelman, CEO Edelman Public Relations

“Disclosure and transparency are the currency of the Internet, and they are at odds with authoritarianism.”

            Evan Osnos, Journalist, New Yorker Magazine

I want to believe.

I want to trust.

I want to hope that the spirit of collaboration amongst treatment professionals who can save the lives of our loved ones exists.

I want to believe that groups like the Residential Eating Disorder Consortium (“Consortium”) and the Eating Disorder Coalition embrace at their core, the best interests of families and those who suffer from this insidious disease.

I want to believe that there is no conflict of interest and that the financial demands of private equity owners do not predominate over the needs of those who are suffering and dying from this disease.

And yet, the Consortium continues to make it so incredibly difficult … and yet, so incredibly easy to distrust, to draw obvious conclusions based upon the facts and their subterfuge and silence.

The Consortium’s underestimation of families, and their collective power and strength has become legion. In St. Paul’s second letter to the Corinthians, he states, “For ye suffer fools gladly, seeing ye yourself are wise.”

The most recent example of the hubris defining the Consortium’s nature was subtly disclosed in November 2018 when the Consortium released its Standards of Excellence Project (“STEP”). As previously noted, the first analysis of this STEP program will be published on Tuesday, January 15, 2019. But, in reviewing the STEP program, an understated, seemingly small issue jumped to light. Whereas 99% of people reviewing the substance of the STEP program would be solely focused on the substance of the document, one tiny detail would escape any notice or attention. At the bottom of the STEP document on certain pages, an address is listed. That address is 555 8^th Avenue, Suite 1902, New York, New York 10018.

And what entity conducts business from that address? Jaffe Management, Inc. Jaffe represents that it is a New York City based company providing full and partial management services to associations and organizations. Jaffe also represents that it provides full management services.

In most every law firm’s portfolio, we list that we provide services to our clients ranging from litigation services to counseling to management. And yet, to always maintain the appearance of impartiality and propriety, we never list our addresses on our client’s public releases or documents.

And so the initial question must first be asked, how significant and all encompassing is the work being performed by Jaffe which merits its address being included on the very document that is meant to define the REDC/Consortium for years to come? Yes, the REDC’s name is included at the top of the document. But the address at the bottom is not the REDC/Consortium’s address. Was the Jaffe Management’s involvement in this document so significant that it merited its address being included as the address for the REDC/Consortium? Why does the telephone number listed for the REDC/Consortium have a Brooklyn area code of 646? No REDC members have offices or treatment centers in Brooklyn.

Standing by itself these issues may not seem particularly pertinent. But, when one investigates additional clients represented by Jaffe Management we find … the Eating Disorder Coalition. The ED Coalition allegedly represents families whose loved ones are suffering from eating disorders. When you go to the ED Coalition website, one can discover that in terms of fundraising, a Gofundme page was set up and links to an entity known as the EDManager on behalf of David Jaffe. David Jaffe is the principal and owner of Jaffe Management. And so, both the ED Coalition and the Consortium are listed as clients of Jaffe Management. The Consortium uses the address of Jaffe as its home address. The ED Coalition utilized Jaffe as the public face of its fundraising arm.

In previous articles, we disclosed that for the last two years, both the Consortium and the ED Coalition have utilized the same lobbyist. Their current lobbyist, Center Road Solutions lists as its managing principal, Katrina Velasquez. Ms. Velasquez is also listed on the Staff of the ED Coalition employed in the capacity of Policy Director.

The Coalition was instituted for the purpose of being the liaison with state and federal agencies, administrators, lobbyists and legislators on behalf of the eating disorder industry as a whole. And yet, many of the same people are employed as officers of both entities. Their lobbyist is the same. The money being paid to the lobbyist is to pursue the agenda dictated by the private equity firms. Both the Consortium and ED Coalition are being managed by the same management company located in Manhattan.

When one considers the underlying facts, there is but one inescapable conclusion … the needs of the eating disorder industry and community are subservient to and are being controlled and dictated by the private equity firms which control both the Consortium and the ED Coalition. These firms wield the financial power to dictate the course and direction of the eating disorder profession. The employment and utilization of the management company, the lobbyists, the financial resources, the focus of the treatment centers are based upon increasing the wealth of private investors and of meeting the financial dictates of future debt requirements.

And for those families who are suffering, and whose loved ones are dying, ask yourself one question … has the death rate caused by this disease, that is, one person every 62 minutes … has this death rate improved at all in the last 11 years? 11 years since the Mental Health Parity Act was passed. 11 years in which the Affordable Care Act was passed. 11 years since private equity firms came into the eating disorder industry and essentially bought out the treatment centers. What has been wrought since the Wild West became the norm for the industry?

Our loved ones continue to die. They are the precious sacrifices we mournfully lay on the altar of profit at the expense of enlightenment.

“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.

100 patients.

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:

1. A laughably low patient population;
2. Only ERC doctors and professionals are involved;
3. Not being overseen or supervised by independent outside third parties thereby giving some assurance of unbiased, quality control;
4. The study’s disclosed, proposed protocol is rife with Confirmation Bias;
5. The underlying data to ascertain the predictors of successful treatment were not disclosed;
6. ERC did not disclose whether this study also involved a “double blind trial”;
7. What objective findings and criteria are being relied upon to determine “success” of the program;
8. What outside agencies, universities and research-based facilities are being used to ascertain and confirm that objective, professional results are going to be obtained;
9. 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.