American College of Physicians: Internal Medicine — Doctors for Adults ®

Thursday, November 12, 2015

National nutrition policy, imperiled by bullies

I know a guy who writes blogs rather prolifically (for which he is uncompensated, by the way). The audience for his blogs is, presumably, people interested in his opinions and his writing; why else would they be there? He writes books, too. And once, he wrote a blog in which he expressed, to this audience presumably interested in his opinion and his writing, his opinion about his writing.

The guy in question is me, and the blog in question was written, like the paragraph above, in the third person, because the writing in question was an epic work of fiction written under a nom-de-plume.

I am guessing that doesn't immediately jump out at you as one of the great scandals of 2015, and I must confess, I am with you. It does not, for instance, seem to be up there with the political theater of the so-called Benghazi hearings, which are exploiting the tragic deaths of our fellow citizens for partisan advantage. It does not seem to rival the ill-gotten gains of fantasy football; the hush money intrigue of Dennis Hastert; or even the well-funded sabotage of America's dietary guidelines.

But there is a group carrying on as if what is confessed above is a great scandal, and there is a good reason. They are the very group employing every means at their disposal to scuttle dietary guidance dedicated to public (and planetary) health to serve their own pecuniary interests, and I have been among those calling them out for conflicts of interest; errors of content; and want of qualifications, every step of the way. They don't like me, in other words.

I suspect most of you know that the report of the 2015 Dietary Guidelines Advisory Committee was issued some months ago. I suspect many of you know that I think it quite stellar. I strongly favor the inclusion of sustainability, which our Congress, in its apparently limitless capacity to subjugate conscience to cash, has already expunged at the shrill insistence of Big Food and Big Ag, and their front people.

I suspect many of you also know that I consider the death of expertise an important loss to the standards of modern journalism. No, it is not a “debate” when a group of highly qualified, carefully selected, scrupulously vetted, multidisciplinary experts says “A,” and Joan Shmo with no relevant qualifications and an obvious financial interest in the outcome says “B.” Presenting such nonsense to us as if a legitimate debate is, in my readily accessible opinion, an insult to our intelligence, and an abdication of journalistic standards.

What many fewer of you have cause to know is that the conflicted parties seeking to profit at the expense of public health by undermining the almost unbelievably noncontroversial conclusions of the Dietary Guidelines Advisory Committee, are bullies. If you challenge their content, as I have done, they seek to assassinate your character. Violence is the last refuge of the incompetent in cyberspace, too.

Through colleagues, I know that I am far from alone in invoking this group's ire, but invoke it I have, simply as a result of doing my job. It is my job to defend public health, and express my opinions accordingly. Those opinions are about objective elements of content, and qualifications, not character.

In return, I have been subject to various forms of harassment for months. The cabal in question has interrogated my lab staff, seeking information about funding sources, then sharing that information via social media in the form of disparaging innuendo. Yes, my lab has conducted industry funded, in addition to publicly funded, research, as is true of most labs. Industry funding is fraught, and cause for precautions, but the derisive innuendo that one's opinion or conclusions are for sale by virtue of it is not merely unjustified, but flagrantly nonsensical. Anyone who has benefited from a modern antibiotic, diabetes drug, statin, or chemotherapeutic agent is a beneficiary of industry-funded research, the pathway to FDA approval for virtually every entry in the modern pharmacopoeia. Modern medicine would not function in the absence of industry funded research.

Along with the social media smear campaign, inquiries were directed to the offices of the Deans of both Medicine and Public Health at Yale, not asserting, but rather implying, non-existent improprieties. All the while, the cabal in question kept re-tweeting one another to make it seem that this fringe group protecting only its own interests actually represented a groundswell; such is the liability of Internet echo chambers.

The latest chapter has been further harassment of this sort, but now focused on the fact that I did, indeed, write a blog about a book of my own in the third person. That story is rather banal, but here goes:

On my own time, and with only my own funding, I wrote and published an epic fiction novel, the first book of a trilogy (now nearing completion). For reasons related mostly to the integrity of the tale, the “author” could not be me, so the book was written under a nom-de-plume. Attempting to preserve that separation between myself and the author, I soon realized that left me with no way to tell anyone interested in my writing about this book, which I honestly consider the best thing I've written. I decided to write a blog about it in the third person, and express my opinion. As noted, the writing in question was not compensated.

But of course, that was a naïve solution. It still left me with no reasonable basis to refer to the book again. So I disclosed that reVision was indeed mine, although it is more correct to say that my imagination is parent to the author, Samhu Iyyam, than to say that she is me. I do, indeed, commend the book to those of you interested in my writing and opinions, since it is a product of the former and expansively probes the latter, in the context of a rollicking adventure. My mother loves it.

Why waste your time, or mine, with a rendering of this utterly underwhelming tale of intrigue? Several reasons.

First, I believe only those of us directly in the line of fire know that the same group committed to scuttling the Dietary Guidelines is quite prone to, and reasonably adept at, harassment and intimidation. The same resources mobilized to pervert dietary guidance away from the health of humans and the environment and toward both corporate and personal profits are being allocated to silence informed opposition. I, obviously, have not been silenced by this campaign, but for all we know, others have. That's ominous.

Second, Edmond Burke, assuming he said it, was quite correct: all that is necessary for the triumph of evil is that good men do nothing. But doing something, particularly in the face of any semblance of “evil,” comes at a cost. I take advantage of this opportunity to say: we should bear that cost.

Third, Supreme Court Justice Louis Brandeis pointed out that sunlight is the best of disinfectants. It is an antidote as well to the disingenuous aspersions and innuendos of bullies keeping to the shadows, be they in alleyways or on the Internet.

Fourth, I take some pride in the fact that the worst thing a cabal seeking to silence me for months could find when they went rifling through my virtual closets was: for an audience interested in his writing and opinions, he wrote his opinion about his writing. I am an honest guy.

Of course, none of us is infallible. Our judgment may go awry even when our intentions do not. If by writing about reVision in the third person I did inadvertently violate anyone's trust, my apologies. But frankly, I rather doubt anyone without ulterior motives was ever troubled by that scenario. The opinions I expressed about the book were entirely sincere, if immodest, representing a blend of intentions, reflections, and aspirations.

Fifth, we should all recognize that when our adversaries are unscrupulous and prone to bullying, we are all potentially vulnerable to smear, no matter how free of skeletons our closets, no matter how devoid of scandal our personal histories. All it takes, for instance, for me to look foolish and defensive is an anonymous call to a university official asking: “isn't it true that Dr. Katz should stop beating his wife?” Providing the response- I never started- nonetheless situates me under the intended overcast of implied impropriety. Such is the work of clever bullies. They don't need to be right, and they needn't even risk the injury of direct assault when innuendo will suffice.

That, then, is the story that does need to be told: a genuine scandal, richly deserving of disinfection, and a bracing dose of daylight. The same constellation of forces and resources that can be used to subvert national health policy to private interests can be marshaled to the purposes of harassment, intimidation, and defamation. The same forces can be applied to deflect and misdirect; imply and insinuate; and propagate the cover of shadows where conflicts are concealed, motives camouflaged.

Make no mistake, whatever the smokescreen: this is all part of a campaign to undermine the public health for private profit. The nation's official position for the next five years on diet for health is on the line, imperiled by bullies. I am speaking out simply because we don't know how many others, encountering the same forces, have decided doing so is not worth the abuse.

I am speaking out because it is.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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