Tag Archives: #anorexia

BMI … Barely Medically Important

In the past few years, the State of Colorado and the American Medical Association reviewed the use of BMI, (Body Mass Index, or perhaps it should be known as Barely Medically Important) as a tool to measure health.

The Colorado legislature implemented a new law. 

The AMA adopted a new policy on how BMI should be used as a measure in medicine.

Both instances represent a more thorough understanding of health, eating disorders and medical and mental health issues. And they are both good starts. But as in all things, there are issues.

American Medical Association

In June 2023, the AMA adopted a new policy clarifying the role of BMI as a measure of medicine.  Aspects of the policy can be found here:

https://www.ama-assn.org/delivering-care/public-health/ama-use-bmi-alone-imperfect-clinical-measure#

In short, the policy states, “Under the newly adopted policy, the AMA recognizes issues with using BMI as a measurement due to its historical harm, its use for racist exclusion, and because BMI is based primarily on data collected from previous generations of non-Hispanic white populations. Due to significant limitations associated with the widespread use of BMI in clinical settings, the AMA suggests that it be used in conjunction with other valid measures of risk such as, but not limited to, measurements of visceral fat, body adiposity index, body composition, relative fat mass, waist circumference and genetic/metabolic factors. The policy noted that BMI is significantly correlated with the amount of fat mass in the general population but loses predictability when applied on the individual level.”

The AMA also modified existing policy on eating disorders calling on the AMA to:

Encourage training of all school-based physicians, counselors, coaches, trainers, teachers and nurses to recognize abnormal eating behaviors, dieting and weight-restrictive behaviors in children and adolescents and to offer education and appropriate referral of adolescents and their families for evidence-based and culturally informed interventional counseling, and;

Consulting with appropriate, culturally informed educational and counseling materials pertaining to abnormal eating behaviors, dieting and weight-restrictive behaviors.

Interesting and somewhat forward-thinking policies which have been debated for quite some time in the eating disorder community.

The Colorado Law

According to data sourced from the Center for Disease Control, Colorado ranks as the second healthiest state in the United States. Its high ranking is attributed to its active lifestyle culture, abundant outdoor recreational opportunities, and a strong focus on healthy eating. It is also known for having a number of tree hugging, Birkenstock wearing, pot smoking, hippie libruls. [I kind of respect that last aspect.]

With its liberal politics and lifestyle and focus on health, it should come as no surprise that Colorado politicians wanted to do away with the much criticized BMI as an indicator of health. And so, the Colorado legislature passed a bill which greatly limited the use of BMI

This bill can be found here:

Click to access 2023a_176_signed.pdf

If you can work your way through this bill and then reach a place of partial understanding, there is much to embrace.  And much which provides confusion.

On the one hand, the some of the substance of the bill states, “… SHALL NOT UTILIZE THE BODY MASS INDEX, IDEAL BODY WEIGHT, OR ANY OTHER STANDARD REQUIRING AN ACHIEVED WEIGHT WHEN DETERMINING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE FOR AN INDIVIDUAL DIAGNOSED WITH AN EATING DISORDER, INCLUDING BUT NOT LIMITED TO BULIMIA NERVOSA, ATYPICAL ANOREXIA NERVOSA, BINGE-EATING DISORDER, AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER, AND OTHER SPECIFIED FEEDING AND EATING DISORDERS AS DEFINED IN THE MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS.

But then, the next part of the bill states, “SUBSECTION (1)(a) OF THIS SECTION DOES NOT APPLY WHEN DETERMINING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE FOR AN INDIVIDUAL DIAGNOSED WITH ANOREXIA NERVOSA, RESTRICTING SUBTYPE, OR BINGE-EATING/PURGING SUBTYPE; HOWEVER, BODY MASS INDEX, IDEAL BODY WEIGHT, OR ANY OTHER STANDARD REQUIRING AN ACHIEVED BODY WEIGHT MUST NOT BE THE DETERMINING FACTOR WHEN ASSESSING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE FOR AN INDIVIDUAL DIAGNOSED WITH ANOREXIA NERVOSA, RESTRICTING SUBTYPE, OR BINGE-EATING/PURGING SUBTYPE.”

Ok, so I am a reasonably intelligent human being. But, what in the blue hell does the language of the bill mean? On the one hand, BMI, ideal body weight or any other standard requiring an achieved weight can only be applied to anorexia nervosa – restricting subtype and binge-eating/purging subtype so long as they are not the determining factor? Well, that doesn’t seem too vague, confusing and subject to interpretation!

It would also appear as if the bill, albeit well intentioned is having adverse effects.  Dr. Elizabeth Wassenaar, the Regional Medical Director for the Mountain and West regions at Eating Recovery Center and Pathlight Mood & Anxiety Center was interviewed by an NBC news local affiliate. This interview can be found here:

https://www.9news.com/article/news/health/doctor-warns-law-designed-to-expand-eating-disorder-treatments-creating-barrier-to-care/73-9ac527d4-9d38-4d67-b212-6067fe53d714

In the interview, Dr. Wassenaar stated:

“On face value, I 100% agree with this legislation,” Wassenaar said. “I absolutely want to see every person who needs eating disorder treatment be able to access it.  And I never want to see someone be discriminated against because of the size of their body, especially when it comes to receiving care for their eating disorder.”

“Unfortunately, what we are seeing is that patients who are in small bodies who are malnourished are actually being excluded from care or being asked to step down before they are ready because we can’t consider their degree of malnutrition as a part of their degree of severity of illness.”

“And the reality is when you have a statute that makes this sort of determination, then it takes the decision out of the hands of the medical providers who are taking care of people with these patients.”

Indeed.

Which brings up the seminal question …

The Question

With BMI being an incredibly troubling issue regarding its use (or non-use) with eating disorders, why hasn’t a definitive policy or statement been released from experts in the eating disorder community? A unified, collaborative statement so strong, so authoritative, that legislatures, organizations and health insurance providers alike adopt it as THE definitive word on BMI.

After all, the research, study and treatment of eating disorders are the raison d’être for our experts’ existence.

Shouldn’t the continued existence of BMI, or the genesis of its demise lie with the recognized experts in the eating disorder community? Those who study it and either use it or decry it as a diagnostic tool.

Envision if you will, some of the most renowned experts worldwide in the field of eating disorders coming together to brainstorm, to share research and ideas. And then issuing a comprehensive study supported by all of the eating disorder organizations and treatment entities. Including representatives from the health insurance industry.

If ever a time existed for this wisdom, this type of collaboration, this coming together as one, that time is now.

And so, the last question is … who is going to step to the plate and turn this into a reality?

Consequences and Ramifications?

On October 25, 2024, Acadia Healthcare is hosting and presenting the event, the 20th Annual Renewed Eating Disorder Conference in Nashville, Tennessee.

First, by all accounts, the organization, “Renewed, Eating Disorders Support” does good work in the State of Tennessee. No vitriol is directed at them … other than addressing their host and presenter of the event at issue.

The event’s keynote address is entitled, “Adventures in Treating Eating Disorders: Sharing Wisdom from a Cumulative 75 years of Practice.” The overview of this talk includes: “The overall goal of this presentation is to provide eating disorder practitioners from all disciplines and all levels of experience valuable knowledge and insight to enhance their effectiveness.”

So, with that in mind …

Is this the talk where practitioners from all disciplines learn that raping and/or sexually abusing patients is a bad thing?

Or is this the talk where practitioners from all disciplines learn that residential treatment centers can employ persons who allegedly commit rape and/or sexual assault but so long as the bottom line is not negatively impacted, you can ignore the rape and/or sexual assault and not be transparent about it?

Or is this the talk where practitioners from all disciplines learn that treating eating disorders is expensive because it demands the highest level of skill from experienced treatment providers? But since that impacts the bottom line too much, you get out of the eating disorder treatment field and adopt an addiction focused regiment which is far less expensive to implement?

Or is this the talk where practitioners from all disciplines can learn that even though a scathing Senate Committee Report was published which eviscerates your organization, so long as it doesn’t impact you from a financial standpoint, that Report is simply not material?

With all of the recent controversies and issues surrounding Acadia, aren’t we justified in believing that reputable eating disorder organizations would shy away from sponsoring or supporting any event in which Acadia is involved? After all, there is precedent. In 2019, after the Timberline Knolls – Jacksa abusive misconduct came to light, NEDA returned a $10,000 donation Timberline Knolls had made. Surely, because of Timberline Knolls and Acadia’s recent issues, in order to show support for the victims of misconduct and criminal behavior and to make a loud statement against grossly negligent entities, organizations would withdraw their sponsorship and pull out of that event.

Instead, let’s look at the sponsors listed for the October 25th event:

Within

ACUTE Center for Eating Disorders and Severe Malnutrition


Alsana


Blue Ridge Eating Disorder Care Center


Center for Change


Eating Recovery Center and Pathlight Mood & Anxiety Center


Equip


Focus Treatment Centers


Healing at Hidden River


Koru Spring


Laureate Eating Disorders Program


Monte Nido


Odyssey Eating Disorder Network


Rogers Behavioral Health


SunCloud


The Emily Program


The Renfrew Center

Like Captain Renault’s quote in the movie Casablanca, “round up the usual suspects,” we see the usual list of corporate entities in the eating disorders field.  

It would appear as if no one … absolutely NO ONE … demands accountability or seeks to impose consequences for reprehensible conduct. So long as money continues to be the primary motivator for the owners of treatment centers, apparently there will be no demand for repercussions for bad behavior. And as a result, the families who are suffering are further victimized. Patients, loved ones, being sexually abused and/or raped by employees. Our most vulnerable population being preyed upon.

And all we hear is silence.

Where is the integrity?

Where is the dignity of human life?

Where is the placing the needs of the patient and families who suffer from this illness first and foremost?

I don’t think I have ever been more disgusted with the eating disorder community. So, some people may wonder why don’t I just leave then?

I don’t have much of a choice.  In 6 days, I will mark 8 years since my daughter, Morgan died.  That personal tragedy put me on this path … this macabre journey which has exposed corruption and dysfunction far greater than any I exposed or experienced in 40 years of practicing law.

I also strongly believe the memory of my daughter, and the memory of others who have died from this insidious illness have been soiled by not just the bad actors in the community, but those who refuse to stand up against the bad actors in the community.

By those who refuse to take a stand. By those who just conduct business as usual. By those who refuse to draw a line in the sand and say, “No more will we stand with those who hurt our most vulnerable population.”

Until then, the message being sent by this community is … a healthy return of investment to Acadia’s shareholders is far more important than providing life-saving care and preserving the dignity of life.

If you are not disgusted and sickened, you should be.

Palliative Care’s Ultimate Loss

Whether it is because media outlets are finding more click bait worthy stories or whether it is because we have finally passed a tipping point, we are finding more stories seemingly on a weekly basis on the attempted intersection between anorexia nervosa and palliative care.

The Shadows of our Demise. The Harbingers of Hopelessness.

In the Netherlands, a 29 year old is allowed to take her own life after suffering from mental health issues.  Her doctors believe they are out of options and have given up hope.

A 34 year old young woman in the Netherlands is diagnosed with an eating disorder, recurrent depression, autism and mild learning difficulties. She said she tried countless therapies but struggled her entire life. And then in 2022, a counselor told her that euthanasia for psychiatric reasons was legal. She made it her goal ever since, admitting that she always thought about death.

In the UK, recently a 19 year old young lady suffering from anorexia died from eating disorders after waiting for treatment. The UK’s overburdened mental health system could not admit her for treatment.

In the United States, a very small sect of treatment providers is embracing medical aid in dying for persons suffering from anorexia. Palliative care for persons with eating disorders has entered our lexicon. This despite the fact that we have no generally accepted standard of care for treating eating disorders and limited knowledge of evolving medical interventions to treat this brain-based illness. The ignorance in the medical and mental health industries has grown so much that some treatment professionals have written, “Terminal Anorexia” (don’t get me started) is the same as Severe and Enduring Anorexia Nervosa.

I can’t help but wonder … for those medical and mental health professionals who support, if not actively engage in physician assisted suicide for those who suffer from anorexia, how many have had a beloved child die because of this insidious illness? Or is it merely an academic exercise impacting persons not of their blood line? How many have felt that anguish that cannot be adequately described and yet, still tears apart your heart and soul to a depth that cannot be fathomed unless experienced? How many of those medical or mental health professionals who have looked into the eyes of a patient suffering from eating disorders and who said, “I can do no more. There is no hope.” have had a child cruelly ripped from life?

Any? Probably not. That type of pain forever changes you.

So, for those medical and mental health practitioners who support physician assisted suicide for anorexia nervosa, let me attempt to describe for you, [as much as my limited abilities permit] the pain, the anguish so deep, so permanent, that it is almost beyond comprehension.

Think of your beloved daughter. The memories. The memories of going on Indian Princess campouts in Southern Oklahoma. And as you walk back to your tents late at night, you are holding her in your arms, she so young and precious, and then you look up and see the blackest of night skies, bright stars so numerous as to be uncountable … you see so clearly, the Hale-Bopp comet. You breathe in your daughter. You feel her so close to you. Her head on your chest, hearing your heartbeat. You see her innocent eyes closing, a blissful smile on her face.

You remember the joy on her face as that very afternoon, she caught her first fish! And she is jumping with elation.

You remember so distinctly the day she was born. And you being filled with an incredible love that captures you.

You think of those many nights helping with homework.

You think of those nights when, because you are a dad and she is a blossoming young lady, she wants nothing to do with you!

Then, you think of those many days and nights when she called you “twins.”

You think of that day when you took her to the circus. How she clapped with joy when the elephants marched in.  And her howls of glee when a circus clown dragged you to the center ring and threw plates with you while thousands looked on.

You remember taking her to Del Frisco’s Steakhouse for her 10th birthday and after the waiter announced all the specials that night, she looks him in the eyes and says… “I believe I will have the lobster.” You laugh seeing the waiter’s incredulous face.  And then smile watching her take each piece of lobster and delicately dip it in butter and eat it with a smile on her face.

You remember taking her to her first opera when she was 7 years old. As intermission happens, she looks at you and sweetly asks, “Daddy, will there by more music after halftime?”

But you also remember years of struggle, pain and heartache.

And then, one dark night. One dark, unholy night, eating disorders claims its next victim. As you are holding her hand, the attending doctor looks up at you and softly says, “She’s gone.”

In your numbness, shock and an anguish that cannot be measured, you realize that you will never be the same. The man, the parent, the daddy you were, is forever changed. Whoever you thought you were … is gone.

After awhile, you come to realize that you will never see the joy on her face when she tells you, “Daddy! I am engaged!” You will never walk her down the aisle. You will never have that first Daddy-Daughter dance at her wedding reception. You will never hold for the first time your grandchild from your beloved daughter.

You will never hold nor hug your daughter ever again. And you will never, ever, ever, ever hear again, your daughter’s voice saying, “Daddy, I love you.”

It is exactly that.  That is what physician assisted suicide for anorexia rips away. That is the dagger to the heart. That precious life. Those precious words. Gone forever.

“Daddy … I love you.”

Harmful Mental Health Ignorance

Words matter.

Especially when those words have been universally disavowed and do not accurately reflect a medical nor mental health condition. Nevertheless, they are thrown out by uneducated medical professionals in a cavalier, irresponsible and harmful manner.

In May 2024, an abstract was published in the Journal of Pain and Symptom Management, entitled, “Consider Concurrent Hospice Care for Patients with Terminal Anorexia.” Its authors were Ingrid Berg, DO, Kevin W. Craig, MD and other initials, and Lea C. Brandt PhD and other initials.

Websites list Dr. Berg’s areas of expertise as chronic diabetes, sepsis, tobacco use, chronic heart failure, insomnia, pneumonia and respiratory infections, stroke, gastrointestinal bleeding, irregular heartbeat, inpatient urinary tract infection, kidney failure and chronic cutaneous skin ulcer. They missed the “kitchen sink.” In addition, there are no references to any expertise in treating eating disorders.

Dr. Craig is at the University of Missouri School of Medicine and lists his expertise as Alzheimer’s disease, geriatrics and hospice care. On the University of Missouri website, Dr. Craig only lists 5 publications.  None involve eating disorders and Dr. Craig does not list eating disorders as any type of specialty.

Lea Brandt, PhD is also at the University of Missouri School of Medicine and lists her expertise as clinical ethics. I found 22 publications authored by Lea Brandt, PhD. NONE involved eating disorders. The only reference to eating disorders and Lea Brandt, PhD is related to the above abstract. Clinical ethics? Thy name is not Lea Brandt on this topic.

With this information, we can safely discern that these “Three Harbingers of Death” have no substantial experience with eating disorders, do not write about eating disorders, do not treat people with eating disorders, have no lived experience with eating disorders, do not understand how eating disorders impact the brain and biological system and have no expertise with eating disorders.

When one looks at the topic which apparently was presented at the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice & Palliative Nurses Association (HPNA) Annual Assembly, combined with media reports of the paper, we can readily see the false statements, the naïve and outright misunderstandings of eating disorders, the dangerous course of conduct supported by these doctors and the dark mindset which infests their souls, assuming they even have one. Their lack of understanding and knowledge on this topic is so egregious and harmful that certainly the State Boards of Medicine in Missouri and Nebraska will be contacted to determine if disciplinary consequences are appropriate for such egregious misconduct.

With this background, let’s address just some of the more open and obvious deficiencies in their thinking and presentations.

First, they believe and represent that, “Severe and Enduring Anorexia Nervosa” (”SE-AN”) is the same as and is also referred to as “Terminal Anorexia.”  The ignorance and falsity in that statement alone cannot be understated.  Good Lord!

While there is no formal consensus on a definition of SE-AN, Hay and Touyz (2018) proposed the following criteria:

(a) clinically significant functional impact;

(b) at least a 3-year duration of illness; and

(c) exposure to at least two evidence-based treatments (Hay & Touyz, 2018).

While SE-AN is clearly a debilitating illness and some do not recover or may die due to complications of AN, studies indicate that most individuals with a protracted illness course do recover (Eddy et al., 2017).

Ergo … there is no “terminal” aspect to it at all.

Contrarily, “Terminal Anorexia” was an ill-advised term proposed by Dr. Jennifer Gaudiani in February 2022. Since that time, an avalanche of papers have been published criticizing Dr. Gaudiani’s paper while also showing that the term, “Terminal Anorexia” is a non-sequiter. Its criteria was fundamentally flawed. In fact, Dr. Gaudiani has repeatedly and publicly called for the term to stop being utilized, that additional study needed to be done and she apologized for any harm which may have been caused.

In short, the unrecognized, debunked theory of “Terminal Anorexia” cannot in any way be compared to Severe and Enduring Anorexia Nervosa except for perhaps in one way … One is a direct path to immediate and certain death. The other is an enlightened, hope and faith based journey which leads to life.

Nonetheless, these three “Specters of Death” insisted on inaccurately utilizing this term with no frame of reference and even though the term has been denounced by every ethical eating disorder research professional and clinician. And yet, there are other great concerns in their presentation.

Brandt (the so-called ethics expert) is quoted as saying, “Going into ethical considerations and debate, the diagnosis of terminal anorexia is relevant,” Brandt said. “And in that there is this intersection between law and ethics that really influences medical decision making. We do have to take into account this legal framework [for] how we make decisions within the health care system. The standard of care [is] a variable, but relevant construct when determining what is ethically indicated.

The first question is how does one diagnose a medical condition that does not exist? A medical condition which has not been studied, accepted nor proposed by ANY medical or mental health organization, group, or persons (except by the initial authors who have since backed away from this term)? The non-existent condition and phrase “Terminal Anorexia” cannot be diagnosed because it is not real. It has not been proposed let alone adopted by the American Medical Association, the American Psychiatric association nor any international medical or mental health association. It is a figment of the imagination, a flight of fantasy. It is Harvey the Rabbit. Not one reputable, eating disorder expert will vouch for its authenticity.

And yet, Brandt also wishes to talk about (1). the legal framework; (2). what constitutes a standard of care and, (3). terminal anorexia? Fine. 

Going in reverse order, of those three issues, two do not even exist.  First, Terminal Anorexia is in the grave.  It was at best, a woeful term of art with no generally accepted criteria supporting it. It is now only being perpetuated by ill-advised, ignorant mental health or medical professionals (like these three) who don’t care how many people are hurt by its application. Second, there are no generally accepted standards of care for the treatment of eating disorders. There is no dispute about that. And so, that only leaves the legal framework, the sandbox in which I play. An area in which these three are about to become personally familiar … and not in a good way.

Brandt then digs her terminal grave deeper by stating, “Determining whether terminal anorexia is an acute condition versus a chronic, life-limiting illness resulting in death “becomes extremely difficult,” she said.

First, once again, terminal anorexia is a made up term with no independent medical or mental health studies supporting it and which has been lambasted by every reputable eating disorder expert. Secondly, every reputable eating disorder research professional, medical doctor and clinician classifies SE-AN as chronic.

Brandt continues with her own grave digging by stating, “Additionally, the variances around terminal anorexia nervosa criteria can make it difficult to determine what is medically appropriate, as well as ways to provide goal concordant care.” Brandt, … there you go again.  THERE IS NO TERMINAL ANOREXIA NERVOSA CRITERIA. And even if there were criteria, your very words decry this criteria when you state there are variances around the criteria.

Perhaps the greatest concern arising from the abstract, media release and presentation is, “A case report from a Midwestern academic medical center about a 20-year-old woman with SE-AN provides an example of end-of-life care for this vulnerable population that is not guideline-focused, but patient-centered. When she enrolled in hospice, the hospice organization offered to cover ongoing treatment while simultaneously providing supportive care services to her and her family.”

TWENTY (20) YEARS OLD? TWENTY (20) YEARS OLD!!! We know that the frontal lobe hasn’t even finished developing until a person reaches 25 years old. Then there is the obvious arrested development so common with addictions and eating disorders. So, who recommended hospice for a 20 year old with anorexia? What reputable medical center would accept that? And, were these three involved in any way with that decision?

These Three Riders of the Apocalypse with no appreciable eating disorder experience take a term that has been completely debunked and try to fit it into their “Escorting You to Death’s Door No Matter What” practice and obvious mindset. They are the very definition of an inexperienced population which has completely misconstrued eating disorders and they latch on to their own ignorant belief that SE-AN is terminal. They obviously do not know that terminality usually means some biological process is irreversible and with relative certainty not going to respond to any available treatments.

Some people have postulated that once the phrase, “Terminal Anorexia” was placed in the public, Pandora’s Box has been opened, the genie is out, and it is never going away. Perhaps.

But I don’t think so. Instead, I believe there must be harsh ramifications and consequences for its perpetuation by ignorant medical professionals. We can rightly deduce that this 20-year-old person with SE-AN whom was escorted to death’s door took place in the medical center where two of them practice.

And so, once more unto the breach dear friends, once more. More research will be undertaken. And then, ethics complaints to the Missouri and Nebraska Boards of Medicine. Ethics complaints to the university medical centers where these people practice. Ethics complaints to every organization in which they belong. Social media blitzes. The irony of filing an ethics complaint against a person who specializes in clinical ethics is delicious.

And yet, these three were given the opportunity to discuss this matter with some of the foremost experts in the eating disorder community. An opportunity for enlightenment and wisdom. An opportunity to study further these complex issues. To date, they have not taken advantage of that offer and opportunity.

For those medical and mental health professionals who insist on using that term and in doing so, hurt a very vulnerable population, their patients, you will be called to account for your ignorance and your negligence. Research and ethics complaints await and are being processed.

These three are the first.

Take Dead Aim

In the past few months, Physician Assisted Suicide (“PAS”) or Medical Aid in Dying (“MAiD”) has been a frequently discussed or considered issue both domestically and internationally.

Canada delayed until 2027, implementation of PAS for people whose primary diagnosis is a mental illness.

Colorado is seeking to expand its existing MAiD law to allow anyone in the United States to benefit (?) from its proposed, expanded MAiD law wherein life-ending medication can be prescribed by an “Advanced Practice Registered Nurse” and a “consulting provider” only needs to be qualified by specialty or experience to make a professional diagnosis and prognosis regarding a terminally ill individual’s illness.

According to the Death with Dignity organization, there are 19 states either considering, or opposing implementation of PAS or MAiD legislation. These states and bills can be found here:

Bills We are Tracking

“Fer it … or Agin’ it.” That seems to be our current society. Our world has devolved into black or white. Right or wrong. Coke or Pepsi. Republican or Democrat. Far Right Religious Loon or Far Left, Extremist Socialist Loon. Your choice has been made easy. Press this button or that button.

So too, with PAS/MAiD. You must either support those bills. Or you must oppose those bills. After all, topics as simple as our very existence, whether we have a soul, what constitutes a sentient being can readily be pigeon-holed into one of two choices.

“Fer it … or Agin’ it.”

In general, people who oppose PAS/MAiD bills show up during subcommittee hearings, present arguments opposing the proposed bill and seek to have the entire bill defeated. The politician’s aide then contacts the money people behind the politician and asks them how they want the politician to vote. The money people make their views known and the politician dances to that tune.

But what if there was another way?

Instead of supporting or opposing PAS/MAiD legislation, what if a specific carve out excluding eating disorders from these bills were proposed as a rider. Therefore, the position would be regardless of whether that legislative bill passes or expires, eating disorders must be excluded. And that is because we simply do not have enough medical and mental health information and knowledge about this illness.

When does Anorexia Nervosa become terminal? Does the medical community even have a remotely accurate understanding of the way eating disorders impact the brain? And if so, why haven’t effective, biologically based treatments been researched, studied and implemented?

We also know there are no generally accepted standards of care. The “experts” in the community cannot even agree about the most effective medical and mental health interventions to treat this deadly mental health illness. For that matter, should anorexia even be classified primarily as a mental health illness?

We know there is no effective collaboration with any other medical or mental health community.

Private equity companies dictate residential “standards of care” and the way this mental health illness is treated. Emphasizing profits over patient safety. Running treatment guidelines through their finance department. Even a former CEO of a residential treatment center is now admitting to this reality.

There are no pharmaceutical drugs which have been specifically researched, trialed and then approved to treat eating disorders. The drugs being used today were all designed to be used for other mental health and medical issues.

What criteria and protocol would be utilized to establish that which constitutes the highest level of treatment care before patients can utilize PAS/MAiD?  

How many years would a patient have to be afflicted with Severe and Enduring Anorexia before a death protocol is appropriate for them? For that matter, can any mental health or medical doctor, within all reasonable medical probability, opine that death will come within six months?

How often has this legion of information been presented to politicians when PAS/MAiD legislation is being considered?

Envision testifying before a legislative subcommittee and instead of making “Coke or Pepsi” arguments before the politicians (arguments they have heard numerous times), an advocate presents the above information and statistics plus much more. Advocates present compelling information, facts, reasons and logic why eating disorders must be excluded from the legislation.

And the law of unintended consequences may result in, while the discussion of PAS/MAiD is going on, we educate those politicians and society about the dangers of eating disorders. The high mortality rate. The dysfunctionalities and lack of understanding of this illness.

We must start to aim for the specific target before us instead of the zip code sized area of discussion and dispute on this topic which is currently raging.

Harvey Penick, the late, great golf coach and instructor had a famous saying, “Take Dead Aim.” This saying is more about a technique for focusing than a philosophy on how to play. By narrowing down to a very specific target you end up focusing in better on what needs to be done.

With regard to PAS/MAiD, we need to “Take Dead Aim.”

The Old Gray Lady and Assisted Suicide

The New York Times was founded in 1851. In its long and storied history, it has been at the heart of important legal decisions pertaining to journalism and the freedom of the press. Since 1896, its slogan has been, “All the News That’s Fit to Print.”

For many Americans, the Times is at the forefront of their consciousness regarding the journalism industry. It is a major news outlet in the United States’ most prominent city. The Times often sets this nation’s news agenda.  All of which makes it that much more surprising when the Times lowers itself to publishing an outdated, tag along storyline devoid of substance and not current on the latest events on a crucial topic.

In this case, the January 3, 2024 article entitled, “Should Patients Be Allowed to Die from Anorexia?” To say that this article fell down the deepest well far below the Times usual standards would be charitable. In fact, this article could have jeopardized on-going debates, discussions and interactions which are currently taking place among mental health professionals on the highly controversial topic of assisted suicide and mental health, particularly anorexia nervosa.

The Times Article attempts to frame issues designed to draw the reader away from one of the most complex issues we as sentient beings face … our very mortality … and simplify it to a plug and play game devoid of any nuance, substance and morality.

The manner in which the Times article fails is legion. So, let’s address just some of its shortcomings.

First, the Times article comes across as a less informative follow up piece to the outstanding article written by Abby Ellin and published in the Washington Post on November 1, 2023. Ms. Ellin’s article was obviously thoroughly researched, and included information from doctors, research professionals, mental health advocates, families and people who have been directly impacted by anorexia’s deadly nature. It explored both sides of this highly volatile issue. Ms. Ellin’s article endeavored to stay current with the rapidly evolving events on this topic.  All of which are missing from the Times article.

The Times article was not current regarding events which have transpired on this issue since June 2023. It did not address retraction of certain articles, medical complaints being withdrawn, or the fact that a broad-based summit occurred in Denver, Colorado on November 17, 2023, or the fact that perhaps our mental health professionals are looking at new ways to address controversial topics. Instead of engaging in seemingly endless academic articles ping-ponging back and forth, face to face respectful engagement took place. Professionalism. Mutual respect. All this important information was missing from the Times Article.

The Times Article focusing on Naomi’s story was understandable. Her story is compelling. How can we not sympathize with her? Her story touches our heart. Her story and the extreme issues and measures she has faced in her life are designed to attract readers and perhaps gain support for assisted suicide for mental health issues. And yet, her story is not representative of the millions of people suffering from anorexia nervosa. There was no counterbalance showing those people who are greatly suffering and yet who are still scratching, clawing and fighting for life.

Now make no mistake. Palliative psychiatry is a topic that has arisen as an important topic of discussion and worthy of studied research and contemplation. However, the Times Article takes this topic and renders it fodder for click bait. If people are looking for substantive information on this topic, the article fails. No mention of criteria or guidelines. No mention of studying biological or more objective signs of mental impairment.

The Times Article also failed in that it did not address the ever evolving understanding of possible biological causes of anorexia nervosa. It did not address the fact that we do not completely understand the biology and neurobiology of anorexia nervosa and accordingly no treatments have been developed, tested, and approved that specifically target the underlying biology. Genetic factors? Nothing. The Times Article also does not address recent research indicating prolonged starvation damages the gastro system and impoverishes the microbial ecology making recovery more painful and more difficult.

The Times Article did not address alternative and evolving medical measures being utilized to treat anorexia.  For example, Ketamine, Psilocybin, ECT: (electroconvulsive therapy), TMS: (transcranial magnetic stimulation), tACS: (transcranial alternating current stimulation) DBS: (deep brain stimulation). After all, don’t our medical and mental health professionals have the duty to explore all viable treatment options before beginning that journey which leads to the end of life? The article failed to explore this issue.

The Times Article unfairly portrayed Dr. Joel Yager in an unflattering light. Dr. Yager virtually attended the November 17, 2023, summit. He heard inspirational stories of heartache and resiliency from Linda and Jack Mazur and heartfelt apologies from Dr. Gaudiani to those who may have been hurt. He not only heard from but collaborated with some of the leading eating disorder experts in attendance that day. He heard the term “Terminal Anorexia” is being abandoned. He heard the commitment from all in attendance to preserve, to work together, to address this volatile topic in a compassionate, intelligent collaborative manner. As such, we are certainly justified in questioning why Dr. Yager was portrayed in such a cynical manner. Was the Times Article accurate in asserting Dr. Yager questioned the ethics and competency of other psychiatrists?  Whether they had become “zealots for the model.” Whether Dr. Yager was ambivalent and equally accepting whether Naomi lived or died. Whether Dr. Yager stated, “Yager told me that he does not regret what he wrote. ‘The main point is that some people die from the disease,’ he explained.” I believe that type of cynicism could not be generated from the Dr. Yager who participated in the November 17, 2023, summit.

The Times Article did not include information about the plenary panel session to be conducted at the International Conference of Eating Disorders in mid-March in New York City. This panel includes Dr. Gaudiani, Dr. Westmoreland, and others, with all sides of this topic to be discussed in a professional, open forum. This highly volatile, emotional, potentially divisive issue which touches our very existence deserves our highest compassion, intelligence and collaborative work. The Article failed in addressing this.

The New York Times is sometimes referred to as the “Gray Lady,” or the “Old Gray Lady.” Initially, the Gray Lady was a term of affection, meaning that the Times was deserving of respect, of measured intelligent thought. This article was the antithesis of the Times past standard.

With at least one of its photos in the article deserving of both a “trigger warning” or inclusion in the National Enquirer, this article was not worthy of being called investigative journalism. The Article took a complex, emotional issue … life or death, and relegated it to a lurid standard that makes “yellow journalism” appear erudite. Even the birds in my birdcage would be offended if I used this Article to line their dwelling.

Perhaps showing that the Old Gray Lady just ain’t what she used to be … many long years ago.

Changes at the Morgan Foundation … The Future Beckons

Progress. Movement. Advancement. Matriculation. Enlightenment. Action which needs to be pursued if a person, organization, business or foundation wish to accomplish their goals and embrace their vision.

So too with The Morgan Foundation.

When the Foundation was started, it began as many foundations do. Born out of a tragedy. Clouded vision. Great passion. Wanting to make a positive difference while at the same time, finding and then preserving a legacy for their loved one who was taken. Believing, perhaps naively so, that the memory of your loved one can be used as a catalyst to inspire others to increase their efforts and service with the noble goal of “saving lives.”

However, unless that foundation or business consistently finds new avenues and means of overcoming obstacles placed before it, it is in peril of languishing and then perhaps perishing. Time marches on. We must stay one step ahead of the tidal wave of mortality pursing us all lest we be overtaken by obsolescence.

And so, the Morgan Foundation boldly marches forward.

New Chairman of the Board

Effective January 1, 2019, the Chairman of the Board of Directors will be Judge John Payton of Texas. Judge Payton’s history and life of service is as unique as the man himself.

Judge Payton was first elected to office in 1990 when he was eighteen (18) years old. In fact, he was listed in the Guinness Book of World Records as the youngest judge ever elected. Then a senior in high school, he defeated a popular incumbent who had been sitting on the bench. He held that judgeship for 28 years and overall was elected seven (7) consecutive times.

Judge Payton had tremendous success with those with whom he has worked in his court. He is a firm believer in servant leadership. Judge Payton created a community service program training students to lead the organization and teaching them how to connect with community needs.  Judge Payton had the students from his truancy court name the program that he led for 28 years….Students On Service…..S.O.S.  Over 30,000 students went through his program performing with him side by side over 750,000 hours of community service in Collin and surrounding counties.

Judge Payton started a juvenile truancy program that has been replicated throughout the State of Texas. Through this program, Judge Payton had the opportunity to help mold the lives of more than 98,000 children who came through his court. It is this exposure to and interaction with so many of our youth that gives him a unique view of eating disorders.

Judge Payton committed his judicial career to serving children and has been recognized by Mental Health of America, Sierra Tucson, and Tough Love Inc. for his exemplary service to his community.  Habitat for Humanity and running his own food bank are just a few ways he has used positive projects to help at risk students.  He and his students built 14 homes for families demonstrating the “learn by doing” mantra, and did it side by side with the kids exemplifying the “lead by example” attitude. 

He has worked with county, state and federal agencies and has extensive experience reading and interpreting legislation. Because he has spent a great deal of time in the Texas state capitol working with lawmakers on legislation, he has an insider’s understanding of the legislative process.

He has been a leader in the Collin County Republican Party for more than 25 years, serving as the victory chair in both 2014 and 2016 and heading up block-walks, phone banks and sign distribution. Because of his extensive work in the party, he has received numerous recognitions, including the Dixie Clem Award, three chairman awards, the Fred & Mazzie Moses Community Builder Award and the John McVeigh Lifetime Achievement Award.  It is this same drive and dedication that Judge Payton will bring to the Morgan Foundation as its Chairman of the Board of Directors.

Judge Payton has seen first hand the devastating impact eating disorders can have not just on those who are suffering from this disease but on entire families as well. He has seen the early signs of this disease and referring numerous teenagers to treatment. And just as he helped thousands of children stay in school and pursue their life dreams, he brings this tireless passion and experience not just to The Morgan Foundation, but the eating disorder industry as a whole.

In conjunction with its founder, Steven Dunn, its new Executive Director, Desiree Whitten, and the Morgan Foundation’s existing Board of Directors we are looking forward to reenergizing The Foundation and have appointed Judge John Payton as the new Chairman of our Board.

New Executive Director

New leadership to the Morgan Foundation is being spearheaded by its incoming Executive Director, Desiree Whitten. Ms. Whitten has decades of marketing and communications experience having leant her considerable talents to corporate entities such as McKesson Financial Center where she was a Senior Manager in Communications; Constant Care Management Company where she was Vice President of Marketing; Farmer Brothers Coffee Company where she was Marketing Communications & Digital Marketing Manager; Fischer & Company where she was Director of Corporate Communications and Quest Diagnostics, where she was a Manager of Corporate Identity/Corporate Communications.

Ms. Whitten is the Aunt of Morgan Dunn and will be utilizing her talents to refine the message of the Foundation and to be a liaison with corporations and entities who have not yet contributed their resources to the eating disorder industry.

Together, Judge Payton and Ms. Whitten will be handling the day-to-day operations of The Morgan Foundation, fund raising, marketing and growing the legacy of The Foundation.

As for …

Steven Dunn … I will still be listed as the Founder. I will give talks on behalf of my beloved daughter. I will continue to write messages which I hope will inspire, amuse, educate and sometimes, infuriate. And yet, the memory of my daughter’s life, her legacy and the incredible good the Morgan Foundation will accomplish for those who are still suffering cannot be tainted or negatively impacted by the battles which inevitably lie ahead.

Talking with Assistant Attorneys General, State Boards of Insurance, State Boards of Psychologists and Psychiatrists, pursuing legislative agendas and negotiating with legislators, instituting lawsuits, assisting as an expert witness in other matters are all matters which are being pursued and involve controversial matters which sometimes must be approached in aggressive manners. Exposing corruption in the industry, exposing those actors who take advantage of those entrusted to their care are all matters which require illumination. And yet, they cannot be allowed to negatively impact the hope and vision for a greater tomorrow.

The mission of the Morgan Foundation … “To Save Lives, One Precious Life at a Time,” must remain sacrosanct.

2019 and the future await.