“The way is shut. It was made by those who are Dead, and the Dead keep it, until the time comes. The Way is Shut.”

            “The Return of the King,” J.R.R. Tolkein, Author

The United States’ economic history is replete with examples of businesses whose collapse and failure caught the world by surprise. And yet, many of the more notable collapses have some common elements. These same elements are prevalent in many of the eating disorder organizations today. And with the changing economic and cultural world which will arise after the Covid-19 Apocalypse passes, these elements may doom some of those organizations to failure … unless they learn to adapt, innovate and reinvent now.

Blockbuster Video

Blockbuster became not just a video industry giant but its stores became social centers in small towns throughout the United States and abroad. Its empire was vast. It had a virtual monopoly over the video industry. Production of VHS tape recorders and then DVD players exploded as a result of Blockbuster stores. Blockbuster went public and its empire of stores exploded in growth. By 2004, Blockbuster had over 9,000 stores globally, counted 60,000 employees and had an annual revenue of $5.9 billion. But, Blockbuster’s fate had already been sealed 4 years before, in 2000.

In 2000, struggling fledgling company Netflix approached Blockbuster about being acquired. Netflix envisioned a future in which streaming videos on the internet was the wave of the future. Unfortunately, Netflix at the time did not have the financial means to fully develop this software and technology. So, they offered themselves up to Blockbuster for the relatively bargain price of $50 million. Blockbuster declined. Speculation exists to this day that Blockbuster declined in part because late fees were a substantial part of its revenue stream and the Netflix model of operation did not include these fees. In fact, at its height, Blockbuster collected annual late fees in the amount of $800 million! This was 16 times the amount for which Netflix could have been acquired.

We know that streaming video today is the goliath, as is Netflix, and Blockbuster ended up insolvent and in bankruptcy. Certainly in part it was Blockbuster’s short sightedness in not acquiring Netflix. But it was also a failure of leadership in not embracing creative innovation. Blockbuster was more interested in protecting its own business model instead of looking to the future.

Sony

In 1978, Sony invented the “Walkman.” In an industry with many competitors, for at least ten years, Sony maintained a 50% market share in the United States even though its Walkman was routinely more expensive than its competitors. This success allowed Sony to purchase CBS Records in 1987. Two years later, it purchased Columbia Records. Therefore, Sony now had the most popular portable music device and the ability to control its product distribution through the acquisition of the record label brands and their retail outlets.

Sony was in the ideal position to expand its market control through inventing the “iPod.” Instead, Sony languished allowing a computer company with no experience in the music business to brazenly jump into the market and then, to dominate the music industry. That computer company? Apple. And the invention of the iPod, followed quickly by the development of the iTunes store established Apple as an industry giant. Apple’s vision and power of innovation allowed it to evolve from a computer company into a consumer electronics company and major retailer behemoth.

So, why did Sony not make this jump? Some experts attribute Sony’s failure to “innovation dilemma.”

Innovation dilemma occurs when established companies in an industry become resistant to perceived disruptive innovation, which threatens their existing capabilities and cannibalizes their existing products. In theory, an assemblage of businesses which could be positively impacted by disruptive innovation might appear to be the best means of assembling the capabilities needed to manage proactive change. In practice, it is more often than not a means of gathering together everyone who has an incentive to resist change.

The executives of music companies, film studios and book publishers did not embrace the opportunities offered by new channels of distribution. They saw these technological developments as a threat to well established business models in which they had large personal and corporate investments. And their lack of vision was a financial and cultural time bomb waiting to explode.

This allowed Apple, with its creative innovation to introduce its vision into a completely new industry and to dominate the competition. The old ideas from old companies mired in protectionist thinking could not possibly compete.

Xerox

Thirty years ago, when an employee needed a copy of a document, more often than not, they were asked to “get a Xerox of that please.” Xerox’s control of the business copier market was so entrenched that its corporate name became synonymous with photocopies.

To sustain this monopoly, in 1970 Xerox started its research department, the Xerox Palo Alto Research Center (“Parc”). Parc was supposed to allow Xerox to look ahead and invent the technologies of the future. And at first, Parc was successful in developing inventions. The Ethernet, the graphical user interface, a commercial version of the mouse and laser printers were the work of Parc. And yet, Xerox was not able to capitalize on the market potential of its own research and development.

Then, in 1984, despite not having invented the graphical user interface or the mouse, both of these technologies were incorporated in Apple’s Macintosh. The Macbook evolved and became a dominant force in personal computing machines while Xerox market share is non-existent.

The lesson learned is that research, development and invention are not enough. In order to creatively and successfully innovate, a company must take its framework and inventions and adopt them to have commercial success. Xerox failed in part because its leaders could not connect those innovations with its core business. Innovation without sustainably profitable business models is only half the battle.

Creative Innovation

The lessons learned from these, and many other examples are many but all have similar foundational elements. Those companies which rely too heavily on protecting their own business interests and ideas (“that is the way we have always done it”) do not attract creative innovative thinkers. Better mousetraps are always being built. Those failed companies generally lack the vision to take their own product or services, incorporate developing technologies and market them successfully. In general, those failed companies cannot envision new financial or cultural possibilities. Ego and hubris dominate. Their own image is more important than the power of the message they are trying to send. And they are passed. And left in the past.

They do not understand that sometimes, that light at the end of the tunnel is an oncoming freight train.

The Eating Disorder Industry and Covid-19

On a national scale, the eating disorder industry is relatively new, is very small and has no particular significance in terms of power and prestige in our Nation’s Capital. Public funding from state and federal entities is a pittance. There is no advertising or marketing of clinical treatment centers or research breakthroughs which capture the imagination of mainstream society. Infighting in the eating disorder community is rampant. Protecting the small pieces of their pie predominate many organization’s mindsets to the exclusion of all else. And now, Covid-19 could be the death knell.

As we struggle to survive the Covid-19 Apocalypse, individuals, non-profits, organizations and corporations must come to grips with harsh new realities. The world is forever changed. Covid-19 has brought the world’s economy to the brink of disaster. Employee lay-offs are massive. Unemployment claims continue to spike to record levels. Budgets have been cut. The Federal Deficit has risen to unprecedented levels.

Those are the facts. That is the reality.

Each eating disorder organization must conduct a thorough self-evaluation and determine if they are a Netflix or a Blockbuster. Do they have the bold, creative innovative thinking and action of Apple? Or are they looking to hold on to their past like Xerox? Are they zealously holding on to their own version of the “Walkman” instead of exploring brave new avenues of funding, of messaging, of collaboration?  Do they possess the skills, experience, intellect and courage to discover the necessary new paths which lay in the future and guide the organization on this path and to a place of success? Or are they doomed to languish in anonymity and failed dreams?

The way is shut. And Covid-19 and its long term economic and cultural ramifications could be the “culling of the herd” in the eating disorder industry and community.

The way is shut.

Covid-19 has created a new reality for peer review doctors, insurance companies and even treatment guidelines. For those persons and entities which do not understand nor embrace that reality, civil and possibly criminal ramifications exist.

Issue: Your son or daughter has a severe eating disorder and is currently receiving treatment at a residential treatment center. This treatment center has implemented lock down procedures to lessen the likelihood of its patients being infected by Covid-19. The insurance company is now demanding that the patient be stepped down from residential care. If that decision is not overturned in the peer review process, the patient, your son or daughter could be forced to leave the residential program and travel home.

That means: your son or daughter could be exposed to Covid-19 in the taxi on the way to the airport; at the airport; in the airplane; at the airport in their home city; on the way home. In addition, your son or daughter could then be subject to a fourteen (14) day quarantine requirement in the (currently) twelve (12) states requiring quarantine for those who travel from outside that state. Further, governors from forty (40) states have issued stay at home executive orders.

To follow up for much needed care from your discharge treatment team at home, you will need to schedule an in-person doctor’s appointment. The doctor overseeing their treatment at home undoubtedly will want to take blood and urine tests to establish a starting baseline for the next phase of your loved one’s recovery. Isolating and physical distancing will exacerbate your loved one’s condition. Of even greater concern, if your loved one has a severe relapse episode or related serious health issue, they will need to be taken to the emergency room.

Since your loved one is receiving treatment at the residential treatment level, it is likely that their immune system has been compromised and they are at greater risk for contracting the Covid-19 virus.

And yet, a decision is made to step them down from treatment that may have been effective and which kept them as safe as possible from exposure. All because the insurance company made a financial decision which was solely in their best interest.

Fiduciary Duties and Duty of Good Faith

Most courts  recognize a common-law (or statutory) duty of good faith and fair dealing with regard to insurance companies.  Courts recognize that a special relationship exists in the insurance context due to the increased bargaining power an insurance company has in the insurance claim settlement process.  Because an insurance company has the ultimate control over the evaluation, processing, and denial of its insureds’ claims, it has the potential to unscrupulously take advantage of its position of power and treat its insureds unfairly. As such, courts hold that the insurance company has the duty to act in good faith and to deal fairly with its insureds.

An insurance company is liable for acting in bad faith if it denies or delays payment of a claim when it knows or should know coverage is reasonably clear.   If the insurance company has no reasonable basis for denying or delaying payment of your claim, and does so regardless, it is in breach of the duty of good faith and fair dealing.

Additionally, if the insurance company does not properly and thoroughly investigate your claim, the insurance company is liable for acting in bad faith.  The insurance company must adequately investigate your claim before denying it.  If the insurance company merely investigates your claim for the sole purpose of denying it, it is liable for bad faith.

For the purposes of reviewing claims for additional treatment at the residential treatment center level, focus is placed on the peer review process.

Peer Review Doctors

Your insurance benefits provider must also employ Peer Review physicians in good faith, physicians who are competent and who must hold the insured’s needs paramount. And yet, by its very nature, the Peer Review physician is occupying an adversarial position to  your treating doctor.

A peer-to-peer review is typically done as a scheduled telephone call between the Peer Review physician acting on behalf of the insurance provider, and the healthcare professional who requested the review. Ideally, the Peer Reviewer applies the health plan’s medical coverage guidelines to the clinical information, uses clinical judgment, and renders a decision. Although the Peer Reviewer is a delegate of the insurance company, allegedly the Peer Reviewer receives no financial incentive to deny or to approve a request.

In practice, the reality is different. A number of medical doctors and counselors have advised that the peer review process is woefully flawed. Stories of peer review doctors being unprepared, of not having all relevant documentation, of allowing their assistants to conduct the peer review, of having no objective, reliable treatment guidelines in place are rampant.

Last year, in the case of  David Wit, Individually and on Behalf of Others Similarly Situated, et al v. United Healthcare Insurance Co., et al, Civil Action No. 3:14-cv-02346, a federal district court in San Francisco determined that United Behavioral Healthcare, in every version of its Guidelines at every level of care placed an excessive emphasis on addressing acute symptoms and stabilizing crises while ignoring the effective treatment of members’ underlying conditions. 

This overemphasis on treatment of acute symptoms was found not only in the admission criteria of the challenged Guidelines but also in the continued service and discharge criteria that applied to all levels of care.

The Court found that the financial incentives infected the Guideline development process. In particular, instead of insulating its Guideline developers from financial pressures, UBH placed representatives of its Finance and Affordability Departments in key roles in the Guidelines development process.

In short, UBH was more concerned about increasing their revenue than the well-being of their insureds. Similar cases are pending against a Blue Cross entity in the State of Florida, against Optum in a state court in Utah and against other insurance companies in other courts throughout the United States.

At this particularly challenging time in not just the history of the United States, but global history, unscrupulous entities which do not take into account the realities of Covid-19 and the manner in which the virus impacts the delivery of medical and mental health treatment will find themselves liable under new theories of accountability. Both civilly and potentially criminally. Especially to our most vulnerable citizens.

Many People with eating disorders have compromised immune systems

A research study  published in the July 2019 issue of the Journal of Child Psychology and Psychiatry, revealed there is a strong relationship between eating disorders and autoimmune diseases, especially in women. The most prevalent autoimmune illnesses in the sample were celiac disease  (related to malabsorption and intestinal sensitivity to Gluten), type 1 diabetes (related to the body’s inability to produce sufficient insulin), and psoriasis  (a skin condition).

Analysis of the relation between eating disorders and autoimmune illnesses showed that in both men and women, previous autoimmune illness was associated with an increased risk for eating disorders. In fact, that study found women diagnosed with any eating disorder had a 114% increased risk of being diagnosed with an autoimmune illness in the following year.

Compromised immune systems are more susceptible to disease.

It has long been understood that people whose health is compromised for any reason are more likely to be susceptible to disease and can have more severe symptoms than a healthy and robust person. A person’s body ravaged by an eating disorder may be an ideal place for viruses or bacteria to take root and thrive. And then take their life.

Both small and large amounts of virus can replicate within our cells and cause severe disease in vulnerable individuals such as the immunocompromised. In healthy people, however, immune systems respond as soon as they sense a virus growing inside. Recovery or possible death depends on which wins the race: viral spread or immune activation.

Civil or possible criminal liability

And so, our current situation is:

1. Insurance companies’ enforce treatment (read, “payment”) guidelines which do not have to comply with generally accepted standards of care;
2. These insurance companies are making adverse, medical decisions refusing to pay for potentially life-saving treatment for patients;
3. The patient’s treating doctor disagrees with the insurance company’s decision and cites reasons supported by the patient’s current symptoms and status using generally accepted standards of care;
4. Ultimately, the peer review doctors almost universally agree with the insurance company’s determination;
5. The peer review doctor knows, or should know that the vast majority of times, eating disorder patient’s immune systems are compromised;
6. The insurance company and peer review doctors have actual knowledge that the insured/patient, with a compromised immune system is being released in an environment in which the Covid-19 virus is rampant and is causing widespread death;
7. The insurance company and peer review doctor know, or should know that being forced to quarantine or isolate away from human interaction in all reasonable medical probability, is going to cause a relapse of eating disorder symptoms;
8. If the insured/patient contracts Covid-19, with their compromised immune system, they are much more likely to succumb to Covid-19.

This course of conduct is ripe for litigation. The failure to evolve treatment protocol and guidelines to adapt to the reality of Covid-19 is at best negligent. At worse, it could cost a business entity millions of dollar in damages. The damages, including exposure to Covid-19 and dying from such exposure are reasonably foreseeable to the insurance company and peer review doctor. And reasonable foreseeability equates to civil liability. And possibly criminal liability.

The crime of “Culpable Negligence” is defined as a course of conduct “showing reckless disregard for human life, or for the safety of persons exposed to its dangerous effects, or . . . which shows wantonness or recklessness . . . [or] an indifference to the rights of others as is equivalent to an intentional violation of such rights.”

Under Florida law, Culpable Negligence may be classified as second degree misdemeanor (punishable by up to 60 days in jail), a first degree misdemeanor (punishable by up to 1 year in jail), or a third degree felony, punishable by up to 5 years imprisonment.

Where the culpable acts of the accused merely “expose” another to a danger without injury, the offense is a second degree misdemeanor. Where the accused’s actions actually inflict personal injury, it is a first degree misdemeanor.

For insurance companies and their peer review lackeys, liability is present. The rules have changed. Parents, treatment providers, fellow insureds, the time is now to be aggressive asserting your rights. COVID-19 is an unprecedented public health emergency – both in the rapid spread of the disease and because of the sweeping nature of some the measures States have taken in their responses to it. Fortune favors the bold. For the sake of your loved ones, for their very lives, you must be bold. It is YOUR turn now.

As we struggle to survive the Covid-19 Apocalypse, individuals, non-profits, organizations and corporations must come to grips with harsh new realities. The world is forever changed. Covid-19 has brought the world’s economy to the brink of disaster. Employee lay-offs are massive. Unemployment claims continue to spike to record levels. Budgets have been cut. The Federal Deficit has risen to unprecedented levels.

One research firm released an analysis estimating that Disney could lose as much as $3.4 billion domestically alone as a result of Covid-19.

The National Basketball Association is expecting a loss of league gate revenue of between $350 – $400 million. And that is just from the cancellation of their regular season.

Our colleges and universities are also being financially devastated by Covid-19. The University of Florida recently reported an estimated loss of $33 million for the spring and summer of 2020 alone. After the financial crisis of 2008, Harvard’s endowment lost 30% of its value. Harvard’s current endowment is the largest of all United States’ universities standing at approximately $40.9 billion. Analysts are projecting a loss equal to or exceeding that 30% as a result of Covid-19.

Both Google and Facebook are projected to lose $44 billion in advertising revenue in 2020.

Unquestionably, non-profit organizations, foundations and entities relying on public or private funding are going to be severely impacted. Many will not survive. This reality began even before Covid-19 became a global catastrophe.

Changes in the Tax Cut and Jobs Act of 2017 while not generally aimed at charitable deductions, reduced the scope of the tax benefit for charitable giving. A higher standard deduction and the limit on the deduction for state and local taxes caused more individuals to take the standard deduction, as opposed to itemizing deductions. As a result, many individuals who were able to deduct charitable contributions no longer claim this itemized deduction. Other changes exempted more estates from the estate tax thereby eliminating the benefit of deducting charitable contributions in those instances.  The Tax Policy Center estimated that overall charitable giving will decline between $12 to $20 billion annually.

And yet, people worldwide tend to embrace their charitable heart in the face of catastrophes. According to the Chronicle of Philanthropy, a Washington-based news agency that tracks institutional charities like the American Red Cross, after the terrorist attacks on 9/11, Americans donated a record-breaking $2.8 billion to help the victims of the worst terrorist attack on U.S. soil.

Americans also donated nearly $2 billion to victims of the gargantuan tsunami that slammed into Indonesia and other parts of the South Pacific in 2004, killing more than 180,000 people. 

After Hurricane Katrina devastated Louisiana, Mississippi and other states, killing 1,723 people in what the Federal Emergency Management Agency called “the single most catastrophic natural disaster in U.S. history,” Americans donated $5.3 billion to the victims of Katrina, according to the Chronicle.

In 2010, United States donors gave nearly $1.5 billion to victims of the apocalyptic earthquake that devastated Haiti, annihilating much of Port-au-Prince and killing more than 300,000 people.

But, Covid-19 is different. Covid-19 was the “perfect storm” which changed all aspects of our world. Life and Death. Financial. Humanitarian. A global epidemic. This will have a huge impact on non-profit organizations. Indeed, the manner in which non-profit organizations, foundations and entities have traditionally operated is now buried in the past.

Non-profit organizations must evolve and creatively stay ahead of this new reality. Many corporations, wealthy individuals and investors which previously invested in the non-profit sector no longer have the financial luxury or means to sustain their past levels of support. The non-profit sector must understand this reality and find alternative avenues of relevance. Or they face oblivion. And many will sink into the abyss.

In the movie, “The Godfather,” anticipating that the five (5), feuding Italian crime families would be going to war, Michael, the Don of the Corleone Family, removed Tom Hagen as the family’s consigliere (“trusted advisor.”) He knew that the Family needed a “wartime consigliere.”  A wartime consigliere is a senior advisor  with the cunning, wit and intellect needed to defeat an enemy during times of open conflict. Unconstrained by the caution and deliberation called for during regular business order, a wartime consigliere acts and plots creatively, perhaps in unorthodox and unexpected ways but understands that the rules and the world have changed. And in order to preserve what is important, he must adapt and stay ahead of the new world order.

So too, each organization must conduct a thorough self-evaluation and determine if their President, CEO or perceived leader is up to the task of leading that organization into the next decade. Do they possess the skill, experience, intellect, bravado and courage to find the new paths which lay in the future and then be able to guide the organization onto this path and to a place of success? Does your leader understand the reality that non-profit organizations can no longer simply approach financial supporters hat-in-hand and ask for donations as they did in the past?

Does your leader understand that because of these catastrophic economic times, your organization must be able to not only completely understand the vision, the mission and passion of their past financial supporters but to embrace their mission? Your leader must convince past and future supporters that they are NOT making a donation to the non-profit organization but instead, are making a sound financial investment in themselves! Your organization must have a product or a service that they can use to partner with their financial supporters to not only accomplish the goals of the non-profit organization but to help their financial supporters rebuild their financial structure. These entities will NOT be your donors but instead, will be your financial and visionary collaborators.

THAT is what a wartime consigliere will and must do for non-profit organizations. They must have vision … Daring … Courage … Intelligence … and be willing to undertake bold initiatives. They must convince their past financial supporters that by investing (NOT donating) in the non-profit, they are actually investing in themselves, their employees, their families. And through collaborating with you, they are making a sound investment.

The non-profit organizations which have that type of wartime consigliere will survive and eventually thrive. Those that do not …

I am attaching the link to an hour long discussion with Dr. John Torous, the Director of the Digital Psychiatric Division of the Beth Israel Deaconess Medical Center. 

He discusses the three major initiatives enacted by the Trump Administration pertaining to Telemedicine and discusses how virtual counseling is likely to impact mental health services in the future.

Dr. Torous on the Mental Health Moment

“In an era of unprecedented medical innovation, we have to do more to ensure that patients facing terminal illnesses have access to potentially life-saving treatments.”

            Ron Johnson, U.S. Senator

“Unprecedented technological capabilities combined with unlimited human creativity have given us tremendous power to take on intractable problems like poverty, unemployment, disease, and environmental degradation. Our challenge is to translate this extraordinary potential into meaningful change.”

            Muhammad Yunus, Economist, Nobel Peace Prize Recipient

With regard to Telemedicine and virtual access to medical and mental health care and providing crucial life-saving medical treatment to its citizens, to say that the United States’ current healthcare system has proven to be woefully inept would be charitable.

But from the fiery cauldron of Covid-19 comes bold, new initiatives for access to care. The business week beginning March 16, 2020 saw a number of unprecedented announcements and initiatives regarding emergency care measures pertaining to Telemedicine and Virtual Health Care.

First Initiative

On March 17, 2020 the Trump Administration announced that Medicare administered by the Centers for Medicare & Medicaid Services (“CMS”) would temporarily pay clinicians to provide telehealth services for beneficiaries residing across state lines for an initial sixty (60) day period. This action was undertaken pursuant to the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. For a review of the 1135 Waiver, see the embedded link:

1135 Waiver at a Glance

Second Initiative

During this initial sixty (60) day period, the HHS Office for Civil Rights (“OCR”) will waive the penalties for violations of the Health Insurance Portability and Accountability Act (“HIPAA”) against health care providers who serve patients in good faith through every day communication technologies such as FaceTime or Skype during the Covid-19 nationwide public health emergency.

Third Initiative

As of March 16, 2020 and continuing for as long as the Secretary of Health and Human Service’s designation of a public health emergency remains in effect, DEA-registered practitioners in all areas of the United States may issue prescriptions for all schedule II-V controlled substances to patients for whom they have not conducted an in-person medical evaluation via telehealth communication systems, provided all of the following conditions are met:

• The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice;
• The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system; and
• The practitioner is acting in accordance with applicable Federal and State laws.

These controlled substances include opioids and benzodiazepines.

The Practicalities in Plain(ish) English

To the extent that any attorney can attempt to explain the complexities of these initiatives in understandable terms using the Queen’s English, I will endeavor to do so.

First, these three (3) initiatives pertain only to those patients who receive Medicare benefits. They do not pertain to Medicaid patients nor to private pay patients.

These initiatives will last for sixty (60) days or for as long as the Secretary of Health and Human Service’s designation of a public health emergency remains in effect.

Some private pay insurance benefit providers have enacted their own emergency measures regarding telemedicine and video counseling. For a review of some of these providers, please go to the following link:

Private Pay Response to Covid-19

If you click on the hyperlink associated with each benefit provider, you can examine the basic information submitted by that insurance benefit provider. As always, for more information contact your HR department, insurance agent or wellness professional for more specific information.

General Rules Regarding Telemedicine and Virtual Counseling

Forty-nine (49) state boards of medicine plus the medical board of the District of Columbia, Puerto Rico and the Virgin Islands require that physicians engaging in telemedicine be licensed in the state in which the patient is located. During this Public Health Emergency, with regard to patients receiving Medicare benefits, this provision has been waived.

With regard to non-Medicare beneficiaries, it is recommended that providers consult with you own state’s licensing requirements. Each state’s licensing requirements can be found at www.fsmb.org. The specific Telemedicine Policies Overview can be found by clicking here:

States TeleMedicine General Guidelines

Medicare patients may use telecommunication technology for office, hospital visits and other services that generally occur in-person. Medicare beneficiaries will be able to receive a specific set of services through telehealth including evaluation and management visits, mental health counseling and preventive health services.

The medical provider must use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home.

Distant site practitioners who can furnish telehealth services (subject to state law) include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians and nutrition professionals.

All states and the District of Columbia provide reimbursement for some form of live video telehealth Medicaid fee-for-service.

Until the HHS Secretary issued its emergency order on March 17, 2020, utilizing Skype and FaceTime for telemedicine and virtual counseling subjected a provider to penalties under HIPAA. When the “public health emergency” expires, it is anticipated that the penalties for violating HIPAA for using those platforms will be reinstated.

Experts strongly recommend that medical and mental health providers utilize HIPAA Compliant Platforms and enter into Business Associate Agreements with those Platforms. Some of those Platforms include; Vidyo, Veesee and Zoom.

What Does the Future Hold?

Since I am neither “The Amazing Kreskin,” nor “Carnac the Magnificent,” it is difficult to prognosticate the future of Telemedicine and Virtual Counseling. On the one hand, the apparent ease of the process with technology in its current form is beyond denial. On the other, there is no doubt that video counseling is still a poor substitute for in person, face-to-face interaction.

With Telemedicine and virtual counseling, we can see and hear the patient. And yet, our other important senses are denied their import. We cannot utilize our sense of smell to detect the presence of alcohol. Our urine, breath, body odor. Researchers believe that certain cancers, multiple sclerosis, liver disease, Parkinson’s, kidney or liver failure can be detected through their unique scents. The manner in which the person interacts with his/her immediate environment is more readily apparent in face-to-face interaction. The sense of touch is also lost. We cannot get an accurate read on the texture, substance and moisture in the skin.

Certainly, once this genie is out of the bottle in terms of telemedicine, it is unlikely to ever be put back in. But, as providers focus on whether they CAN provide virtual counseling, the more fundamental question of, “whether they SHOULD provide virtual counseling” is not being asked or examined.

The expanding role of technology in medical and mental health must surely be embraced. But, it must be done so intelligently with a basis in science and with a greater understanding of the human condition.

The Mental Health Moment

To obtain additional information and to address any questions you may have on this topic, I urge you to tune in to the Mental Health Moment on Tuesday, March 24, 2020 at 8:15 a.m. on DFW radio station 1160 AM or www.bigdtalk.com or on Facebook Live at JP, Kathy & “The Crew.” Dr. John Torous of the Beth Israel Deaconess Medical Center is going to address these quickly evolving issues and will answer any questions you may have.

Dr. John Torous

I don’t often write about my daughter Morgan. Those who do read my musings, (and thank you) know that she died on October 30, 2016 after battling eating disorders for over seven (7) years.

But, here is the cold reality. The world has moved on. Even her closest friends have moved on with their lives. Whereas, her transition will always remain a personal tragedy for me and her mother, the eating disorder community and industry has moved on. That is understandable. I expect nothing less.

To address an even greater, perhaps even more harsh reality is the fact that if I constantly posted photos of her on social media, if my musings and writings focused almost exclusively on Morgan and her death, I would be readily dismissed as a grieving father who will never get over her death. A person to be pitied … and then, quickly dismissed.

Now, I will always be a grieving father. That is also a reality. But, pitied and dismissed? No. 

Before Morgan died, life had made its own plans for me. I led a life of relative anonymous superficiality. The depth of my soul was measured by the thimble-full. I represented clients in courts, including at least 20 federal courts outside of the State of Texas, with passion and what I thought was purpose. Creativity and expertise were those qualities to which I aspired. My character flaws were many. At the end of my days, the wording on my tombstone inevitably would have read, “Steven Dunn, He was a damned good attorney and pretty good dad.” And then, October 30, 2016 happened.

In the blink of an eye, a person’s world is turned upside down. A person’s life is shown to them in stark patterns of contrasting black and white. And you may wonder, is that all there is? Is the wording on your tombstone the sum total of your existence?

After a beloved child is taken, for persons of a certain constitution, those persons’ burning passion drives them to bring meaning to the death. By God, there will be a great purpose to what may appear to be a senseless death! You will change the world for the better. And through your sheer force of will, people will stand up, understand and be inspired. Your child’s legacy will not be minimized! And so your journey of redemption and salvation begins.

While you pursue this holy crusade, you often feel like a lone pilgrim in an unholy land. You believe your vision is clear. But, it is not. That “clear vision” is a façade. And you are not even remotely aware that you are operating in a complete fog. You reach out anywhere and everywhere believing you are helping. You are creating “awareness.” Your child will not be forgotten! You raise money. If you have the resources, you arrange mini-conferences or speaking engagements. TEDx talks? Sure. Anywhere. Everywhere.

Then, if you are lucky, as more time goes by, clarity starts to come to you. If you have some skill at writing, you encounter times when the words just flow through you. Words just appear on the screen. Those words are not coming from your head. You feel as if you are a conduit for a deeper, stronger message. And you learn to just let the message appear.

Perhaps you question your religious or spirituality notions or ideas. Not in a mean spirited or aggressive manner. But, in a more inquisitive, open, non-judgmental way. Perhaps you read texts or treatises you would never have previously considered. And you feel your heart open to possibilities never before considered. You marvel at the wonder of God, the soul, the infinite possibilities of our existence.

Perhaps you rededicate yourself to exercise. On walks through your neighborhood, you notice the wonder of life surrounding you. How certain trees bloom at different times and in different colors. The dazzling robin’s egg blue of the sky after a front with rain blows through town, leaving a pristine cloudless sky.

Yes, you grieve still. That is a part of you just as surely as any other emotion. And always will be. But, that grief starts to manifest itself in different ways. As you feel yourself staying on a “path of enlightenment,” the messaging just seems “right.” You are able to look deeper into and overcome your past perception of people. Fresh ideas. Open minded listening to other people.

Internal strength, hope and resolve within grows on a daily basis. And with it, a realization that those qualities, instead of receding, are increasing in intensity. A peacefulness within your heart, your soul, envelopes you. You reach a point where you no longer have to force a direction for your gifts or skills. You no longer have to hunt opportunities. Instead, those opportunities seek you out. Becoming a conduit for a greater, powerful message requires that you completely remove your own ego from the equation.

And when you are successful at that, your mission, your vision become so incredibly clear. For the first time, you realize that the mission and vision you claimed as your own, never really belonged to you in the first place. They belong to something far more powerful. You realize that this vision and mission have always existed. They exist within us. They surround us and exists all around us. Your vision and mission were created and honed by the millions of people who came before you. Those who previously suffered through pain and anguish and tragedy. And who came out the other side.

You realize you are but part of a far greater calling. In opening your heart and your mind, in opening your very life essence to possibilities you not only never before considered, but you didn’t even know existed, you reach a place of strength and peace, of joy and understanding of sadness, of wisdom and tolerance of foolishness even when it is your own. You have begun your arrival.

Immediately after Morgan died, a dear friend gave me a card which in essence read: “When faced with an unspeakable tragedy, 1 of 3 things tends to happen to people; (1). It destroys them, (2). It forever defines them in a negative way, or (3). It fills them with incredible strength and resolve.”

I believe that people do not get to choose which of the three things happens and comes to define that person. It wasn’t until this past week that I encountered a possible name and identification for the third aspect. Some people call it, “Post Traumatic Growth.” (“PTG”)

I am attaching two articles on PTG:

Pro-PTG

Con-PTG

For the most part, the Pro-PTG article seems to track some of the observations and experiences I have encountered along the way. The con-PTG article tends to discredit the notion of the existence of PTG.

The pro-PTG article indicates that not only is PTG very real, but it is something that can be acquired. It can be learned. The con-PTG article attempts to debunk this supposition and draws a distinction between “perceived growth and actual growth.”

Both articles are compelling. And yet, I believe where both articles fail is that they do not explore the possibility that we can no more control whether PTG will define us as we can control whether PTSD will destroy us. Our soul, our life essence cannot be recreated in a laboratory. Our very nature, who we are at our core is beyond science. It is beyond our corporeal understanding.

PTG? I don’t know. I do know a path has been placed before me. And it is the right path for me. A path that was paid for with the dearest blood possible. Who would I be if I chose to leave that path?

To that last question, I will not have an answer. The path is before me. And I am finally ready for the many rigors and challenges which await on that path. The next step beckons and calls. And I answer its call with an open heart, open eyes, strength and resolve within … and I hope, wisdom and understanding.

My tombstone has been wiped clean. Only now, as I stay on this path, the words being carved on that tombstone could read, “Steven Dunn … In His Daughter’s Name, He Helped Save Many Lives.”

“Great moments are born from great opportunities.”

            Herb Brooks, Hockey Coach

Sometimes the darkest of tragedies provide beacons of opportunities. As a collective society it is far too easy to become set in our ways. “We have been doing things, this way, for as long as I remember, it seems to be working, so why change?” The money flows in. We help some people. We believe we are on a path of righteousness. We are going to leave the world a better place than what it was when we first came into it.

And after a promising start, complacency starts to set in. Our vision becomes focused inward, instead of outward, always outward. The voices we most listen to parrot our own beliefs and views. Opinions which do not coincide with our own are disregarded and dismissed. We employ only those people whose opinions on issues and strategies coincide with our own. Our own knowledge is safe. And then, growth begins to slow. What started out as a bold and noble vision sees a decline in passion, then stagnation and finally descent into oblivion.

This descent is sometimes hastened by the unexpected and unforeseen. A tragedy. A pandemic. The sudden death of the leader of an organization. And in the blink of an eye, “holes of despair” which had been appearing and growing in number and severity in our previously “safe vessel” are revealed. Holes to which we had turned a blind eye. Sometimes willfully. Sometimes out of naivete or inexperience. Our organization, our world is rocked. Perhaps we find ourselves standing on the precipice of financial disaster. We look around at those people whose views mirrored our own, people who also did not see the holes because they thought like us, acted like us, and we see fear, anxiety and confusion on their faces. Many times those people are looking solely inward, their first and primary thought being on self-preservation … on how they can save their own livelihood. They run for the nearest life boat.

Financial Armageddon awaits. As does our own destiny. And on the surface, it is not what we thought it would be. It was not what we had planned. We hope for a miracle. We hope for deliverance. We are facing Financial Armageddon.

Or are we? 

For most people, their own perception is their reality. We can see only the here and now. When we shun others, when we are not open to other people’s viewpoints and ideas our tribal mentality handicaps us and defines us in a very narrow manner. Fear of the unknown. Fear of new ideas. Fear of failure.

Financial Armageddon?

Or an opportunity to rise from the ashes of despair and boldly embrace new ideas that a previously unexplored path could provide?

Covid-19 has changed the global landscape in every possible manner. Educational institutions. Businesses, large and small. Entertainment. Dining. Travel. Life and Death.

Conferences and conventions in all major United States’ cities are being cancelled. The eating disorder community and industry are being hit hard by closures and cancellations. iaedp’s 2020 Symposium scheduled for March 26 – 29, 2020 was cancelled. The leaders of iaedp are attempting to devise a plan to reconstitute the Symposium virtually. Many obstacles and the realities of a fractured community weigh heavily against a successful implementation of that venture.

On March 14, 2020, the Eating Disorder Foundation cancelled or moved all support groups to a virtual format.

Beat and the Royal College of Psychiatrists’ Faculty of Eating Disorders announced that the Eating Disorders International Conference scheduled for March 18 – 19, 2020 at  the University of Strathclyde was cancelled.

The Eating Disorder Coalition Advocacy Day on the Hill scheduled for May 13, 2020 has been postponed to September 23, 2020.

It is likely that a number of NEDA walks will be cancelled.

AED’s annual international conference, ICED 2020, scheduled for early June 2020 in Sydney, Australia is clearly at risk. Cancellation or postponement of ICED 2020 may be inevitable since ordinarily, the cost and time expenditure to stage an international convention escalates as the date nears.

An uncertain future, fear, confusion, frustration for an industry. Except for that one organization, that first organization, which understands that all aspects of the future are uncertain and unknown. That organization will understand from adversity comes a greater opportunity to rethink past conduct. That organization will be willing to boldly explore new partnerships, more powerful collaborations and to embrace new ideas and new concepts.

That first forward thinking organization will understand that instead of harping on the discredited statistic, “95% of all diets fail,” and organizing petitions of protest that are as inane as they are ineffectual, it will explore ways to partner with the wellness industry. It will inspire the research professionals in both the eating disorder industry and wellness industry to work together to develop specialized eating plans that more thoroughly provide nutrition to the body, and the brain.

That first forward thinking organization will understand that instead of turning away in a belligerent and obtuse manner from the pharmaceutical industry, it will utilize its best and brightest minds to start collaborative studies with the research departments of pharmaceutical companies to research then implement a prescription drug regiment tailored to address the unique needs of those people who suffer from eating disorders.

That first forward thinking organization will understand that instead of ignoring the vast financial resources of Fortune 100 companies, it will find opportunities to introduce itself to those companies. It will convince those companies that the mission and vision of those companies mirror the vision and mission of that forward thinking organization. And should those Fortunate 100 companies truly embrace their own vision and mission, they will be not only furthering the vision of that forward thinking company but will also be acting in its own financial best interest.

That first forward thinking organization will understand that instead of relying on the handouts of a few private companies and foundations, it will understand that the Tax Reform Act of 2017 changed the rules, that public funding is too sparse and will find new revenue streams from its new collaborations and partnerships.

That first forward thinking organization will understand that it can no longer rely upon the corruption and ever changing winds in our Nation’s Capital to push forward ineffectual bills which statistically fail 94% of the time. Instead, it will find broader, more expansive marketing and advertising outlets and media such that its vision and mission are distributed to a vast audience.

Covid-19 has provided problems and issues of all type and manner which need to be addressed. Covid-19 has taken lives. Inevitably, Covid-19 will cause some businesses and persons into financial peril and then, bankruptcy. But, Covid-19 will also provide unprecedented opportunities. Opportunities for advancement, for growth, for success.

Opportunities for that one, that first forward thinking organization.

“We stood up for what was right. We fought for moral reasons … We sacrificed … We … cured diseases … We reached for the stars, and we acted like men. We aspired to intelligence; we didn’t belittle it; it didn’t make us feel inferior. We didn’t identify ourselves by who we voted for in the last election, and we didn’t scare so easy.”

            Jeff Daniels as Will McAvoy, Newsroom

The political system today in the United States is perhaps as fractured as it has ever been since the Civil War. The two major political parties, more concerned about perpetuating their own power, have lost sight of what was a far greater purpose. The ability to listen intelligently to issues which have the potential to increase the divisiveness, the ability to hear, to understand another person’s point of view is on life support. The ability to disagree on issues in a professional manner while still respecting the person who disagrees with you is becoming rare. Our politicians “personalize” disagreements on issues. If we disagree about the manner in which we address social or economic issues, then surely we must disagree about the substance of their soul. If you are not my friend agreeing on each and every point, you are my enemy.

Politicians obviously believe that the substance and conviction they believe they have on their own points of view are not substantive enough. They must also belittle and run down their opponents. Spirited, healthy, passionate debate on the issues is becoming a lost art. The focus now seems to be, “Elect me! I am the voice! Only I can lead us to a greater tomorrow!”

When was the last time you heard any politician say, “Believe in our shared vision. Believe in a tomorrow we can be proud of, a tomorrow of hope and promise. Our shared vision is the important thing. ”

Our political system is fractured. As we continue to personalize our political differences, as we allow our political views to define the very nature of who we are, we too suffer. Our unified voice as a nation is being muzzled. We are becoming known not for our collective might and vision, but our paralyzing dysfunction and divisiveness. Shrill voices crying out for attention while trumpeting their own self-importance distract the nation from our issues, worries and concerns.

Transparency, the integrity of our politicians, honesty, compassion, the ability to listen, learn and compromise in the spirit of a greater good are being lost. We allow fear to blind our collective vision.

Study after study show that people gravitate toward articles, issues and viewpoints which coincide with their own beliefs and points of view. We know what we know. Our own knowledge is safe. Since our point of view on a subject is bolstered by others who share that same point of view, then we must surely be correct and our perceived self-worth increases. We personalize our viewpoints. If you do not agree with my point of view, since my self-worth is now tied into that point of view, that means you obviously do not like or respect me personally. As a result, the divide widens, compromise is much more difficult and respect is lost.

Unfortunately, the eating disorder community is but a microcosm of our political system. And our children are the ones who suffer.

Disparate views breed contempt. A complete lack of transparency. Groups working in open opposition to other groups. Persons engaging in a concerted, shadowy campaign to slow down, undermine and destroy the work of other professionals, clinicians and doctors. Other Advocates, aware of that campaign of hatred, remaining silent.  And our children are the ones who suffer.

Personal agendas. Refusal to listen intelligently to viewpoints which differ from their own. Refusal to listen at all. Refusal to be open to change and evolution of treatment options and ideas. Refusal to explore collaboration with other healthcare industries and intelligent pharmaceutical intervention. And our children are the ones who suffer.

Our own fear dictating our course of action as the path we believe that is laid before us is blocked by our lack of vision and myopia. Our belief that only WE, and those who believe exactly as we believe, are the only ones who are right and all other voices must be extinguished. And our children are the ones who suffer.

We listen to our own fear. Our fear manifests itself as a growing and powerful voice in our head. Our fear seduces us. Our fear makes us believe that we are the only ones who are right! Our fear convinces us that everyone else is wrong and they are trying to hurt us! Our fear makes us believe that fear is truly our friend. Our only friend. Our fear will protect us. Our fear will guide us. Our fear will never let us down. Our fear wants to become one with us. Our fear wants to become us. Our fear tells us not to listen to anyone else.

And we start to believe our fear. Our fear becomes our friend, our lover. Our fear will never hurt us. We become our fear. And our fear becomes us.

And it is only after our fear has destroyed our ability to listen, to learn, to love, it is only after our fear defines who we are, it is only after we have become our fear to the exclusion of all else, that its true nature is then revealed.

All the time, our fear was nothing more than our eating disorder demon manifesting itself with a different mask. Seducing us. Continuing to destroy our soul. Claiming another victim. Another life. Another soul. Our fear is the greatest obstacle to progress. Our fear is another manifestation of this insidious demon. Our fear.

And our children are the ones who suffer.

So, one organization had the insight to designate the last week in February as  “Eating Disorder Awareness Week.” And good for them.  And for those in our insular community, we embrace it … as we rightly should.

During  this “eating disorder awareness week,” a dear, passionate, insightful lady took me to an upscale, French restaurant in North Dallas. The escargot, served NOT with garlic and butter as most French cuisine restaurants will, but instead, with a creamy, buttery sauce which accentuated the delicate texture of the escargot was nothing less than sublime. The Sancerre wine added to the complexity of the taste. This culinary explosion was followed by scallops served over truffle infused risotto. The lingering tastes created a lasting impression of the perfection of taste, scent and touch. And then …

The true cruelty of eating disorders hit home. Eating disorders take an experience that can give such pleasure, such joy to a person… and bastardizes it in the most perverse way. When we dine with  a loved one over a meal, when we share a meal, even if it is as simple as sharing “Kale Wednesday,” when we dare to share the joining of our emotions as expressed through a meal, we draw closer not just to that person, but we embrace their very essence with us. We express our eternal love for our mate. We laugh and cry with a person with whom our soul recognizes its counterpart in another. We dare to  laugh. We dare to cry. We dare to share.

But then, this insidious disease takes this incredible bonding experience, our love of the tastes and textures and love of food, … and bastardizes it in a most cruel and perverse way.

We fall in love when we dine with someone, we embrace a meal as a shared, joyful experience. We laugh. We love. We look into each other’s eyes, we look into our souls when we share a meal… and this disease turns that sacred experience into a cruel, deadly march to death. How dare it! And how dare we let our pale and shallow egos allow it to perpetuate its dance of death.

How dare we … How dare we …

The ghostly specter of eating disorders takes this loving, shared experience and turns it into a painful, hopeless march toward death. Each bite reiterating a macabre, agonizing and perhaps inexorable path toward the grave.

The taste of food, the taste of joy, the taste of life, being cruelly ripped from our loved one as it is thrown in their face. What should be one of their most joyful experiences turned into a sensation of pain and anguish.

And all the while, we as a community stand by helplessly and do very little. We put on our little walks. We raise money to perpetuate our own self-perceived importance. Some of our so-called leaders, so imprisoned by their own pain and anguish, intentionally raise obstructions to others in the industry. And yet, we then pat ourselves on the back as we shout from the tallest treetop that “we are raising awareness.” Meanwhile, our beloved children continue to die. And we as a community cannot even deign to speak their names aloud.

How dare we … How … dare … we.

Our beloved children and loved ones continue to die.  We are forced to lay our beloved children on the altar of the industry’s hubris. We have given the ultimate sacrifice. So, as we light our little buildings in shades of green and blue this week, let us never forget those incredible souls whose lives have been ripped from this world. Let us call out their names, loudly. Those are the army of Warrior Angels for whom we are fighting! Let us never forget them. And let us never forget the moms … and the dads.

Let us remember those souls who have to live the remainder of their days with the guilt, the anguish, the shame, the incredible pain that only a parent who has had the most precious thing they hold dear  ripped most cruelly from them have to endure each and every day … until their very last day.  How dare we not raise them up. How dare we not honor them. How dare we disregard them. How dare we disrespect them. They have paid the ultimate price.  They have made the ultimate sacrifice. They have paid with the dearest blood possible.  How dare we forget them.

How dare we. How dare we.

“An apology offered and, equally important, received is a step towards reconciliation and, sometimes, recompense. Without that process, hurts can rankle and fester and erupt into their own hatreds and wrongdoings.”

          Margaret MacMillan, Historian and professor, University of Oxford

“Forgiveness does not change the past, but it does enlarge the future.”

Paul Boese, Author and publisher

“The ability of a person to atone has always been the most remarkable of human features.”

           Leon Uris, Novelist

Eating Disorder Awareness Week is upon us. Once again. For those of us who have been impacted, and maybe even devastated by eating disorders, perhaps this next week is the best time to take stock of our own situation, outlook, views on the industry and … ourselves.

A number of people in the eating disorder community and industry hold to their belief that the eating disorder realm is more fractured, divided, and divisive than at any time before. Clinicians and research doctors failing to trust and collaborate. Advocates and activists alike advancing their own single causes to the exclusion of all else. Little transparency. Failure to communicate. Attributing false and nefarious motives to others who disagree with us. Not placing trust in others. Placing ones importance and ego over the importance of the messaging. Ignoring the families who are suffering from this insidious disease as we hide behind our hubris. Reliance on statistics which have no basis in fact.

Some have shaken their heads, despondent, wondering how we ever reached such a place. And they wonder how we can possibly get out of this dark pit of despair.

I am self-aware enough to know that I certainly do not have the answers or even a roadmap leading to a path of enlightenment. In fact, on some occasions I have unfortunately contributed to the dysfunctionality. But …

A number of life altering events have enveloped me since October 2019. First, on October 24, 2019, my father of 88 years passed away. He lived a full and complete life. And the last life lesson he taught his children was how to face your own mortality with grace, with strength, with courage, with dignity.

October 30, 2019 marked the third commemoration date of my beloved daughter, Morgan being taken by this disease. Significant dates are always very difficult for parents whose children have been ripped from life.

In mid-January 2020, I got to witness the coming to fruition of one man’s hopes, one man’s passion, one man’s belief in the fundamental goodness which exists within us all. I got to witness how one man, one man of intelligence, wisdom and courage, brought together some of the most renowned eating disorders experts to Dallas, Texas. They came because they were drawn by the purity of the message and a faith in a better tomorrow. For the many who did not get to hear his vision, his heart being put on display, his passion in his opening remarks, just know that this meeting was aptly named … and for the remaining time at this event, there was a feeling of hope, real hope.

About 10 days after this event ended, I was asked to participate in a videotaping. A dear friend had organized a small group of parents all of whom had had a child taken from them. The father who went right before me, his beautiful daughter had been taken in a tragic automobile accident in July 2019. She had suffered from addiction issues for years, issues which are believed to have contributed to her demise. Through my eyes I saw a father in agony, in such excruciating pain. And yet, this dad spoke so quickly, never looking at the camera or interviewer, trying to convince us in the room that he was ok, that he is counseling people on grief since “he is over it” and that he is training for a triathlon. It was at that point, that I knew that I was looking at myself over 3 years ago. This dark fog of despair clouding his judgment and self-awareness. His eyes darting around as if looking for a place to escape while all the while, denying the necessity or existence of such an escape. I was looking at a mirror image of who I was in a dark and foreboding place … a place to which, through the grace of God, the universe or whatever divine spirit you believe in, I was allowed to leave. To leave with a purpose. To leave with having my soul find me. Leave, yes. But, never forget.

On the heels of that revelation, came the discovery of a cruel, social media post imputing false and libelous actions which could be construed as being directed against me. Righteous indignation and anger coursed through me. I considered immediate legal action. And then? All of the events which had occurred since late October washed over me. And a realization that for those of us who have been impacted by this insidious disease, we all suffer pain in our own unique ways. With some people like me, the scars are open and obvious as they are with any parent whose beloved child has been forever taken. For others, those victims of eating disorders who still breathe, victims who still bare the horrible invisible scars left upon them in the wake of this damnable disease they must surely bare their own pain in their own way. We share this horrific bond. The bond of anguish and pain, pain left as a calling card as a result of this disease. And then came clarity. There was no need for retribution. But compassion. Compassion and love. Love as we are all loved by our parents and our eternal Father.

And perhaps that is from where the healing in the eating disorder community and industry must come … our own compassion, giving one’s self up for forgiveness, to apologize for past missteps. To bare one’s soul, openly and without shame. And when this realization came to me, there was no doubt in my mind where a start of the healing in the community and industry could possibly come from. I only needed to look into a mirror. Into my own heart. To acknowledge my own flaws and to make amends. As I surely must.

To those whom I have hurt through my writings, words or actions in the past three (3) years, I offer my most sincere and heartfelt apology. There will be no excuses. Excuses only serve to diminish the sincerity and depth of my apology. I have committed wrongs. And wrongs must surely be addressed.

But, a general apology is not enough. Specific acknowledgements must also be made. If we are to march bravely forward, we must first acknowledge where we have failed … and pledge never to so fail again. And so …

To Chase Bannister, for those times I have tried to belittle you, for those times I have not approached you as a professional and not acknowledged your passion in this cause, I apologize.

To Jillian Lampbert, for those times I have not seen the strength within you, your desire to do the right thing in incredibly trying circumstances, I am sorry.

To Dr. Ken Weiner, for those times when I was brutal in my analysis of your motives, for not acknowledging your desire to save many lives in the future, I apologize.

To Laura Collins Lyster-Mensh, for those times when I was personally harsh in my criticism. You are better than that. And my differences with your views could and should have been expressed in a kinder, more professional, productive manner. They weren’t. And I do apologize.

To Chevese Underhill Turner … for you, I have disagreed with a number of your views. But, I was not gracious, professional and respectful in expressing those views. You did not deserve that. Simply saying “I am sorry” does not seem adequate enough. I will strive to be better, to be more open, to seek common grounds so that collaboration and open communication is possible. Look within your heart. I do want the same thing as you… to help and save as many people as we possibly can.

To Karen Barton.

To those others in the eating disorder community and industry, those unnamed or unrevealed persons whom may have taken offense, I hope you find within your heart forgiveness and the willingness to embrace my intentions.

I will continue to write as surely I must. We may and undoubtedly will continue to disagree on some issues. For that, I will not apologize. But, before writing, I pledge to first approach you in a spirit of good will. And if you choose to approach me, you will be met with courtesy, professionalism and respect. We serve a common goal. We must together continue to strive to save lives. Of this we have no choice. But, going forward, from my part, I hope to be able to accomplish this must more intelligently, with a greater sense of understanding and compassion.

Unfortunately, I also know that it is an inevitable reality that I will continue to make some people in the eating disorder realm uncomfortable. For I represent the face of the failure of this industry and community. When a child dies and a parent is left behind, you will see that in my face. It is a grim reality.

A better future awaits us. We MUST find a path of compassion, of love, of forgiveness. Our beloved children are depending on us. We must be better. We must do better. We must have our actions be dictated from a place of faith, of hope. We must embrace our tomorrows with the promise that we will do better.

I know I will. In Morgan’s name. In Kelly’s name. In Erin’s name. In Heidi’s name. In Maggie’s name. In Kayleigh’s name. In the name of the thousands in the Army of Warrior Angels who are taken each year.

We must do better. We will do better.