Tea Leaves

Physicians for the Unethical Misuse of Patient Information

So I've been following this "PCRM reveals that Atkins was fat when he died!" trainwreck for a while now, and I have a few comments.

I think it is a great example of how ideology is more important to interest groups than facts. I think it is a great example of how invalid reasoning is used by interest groups to arrive at conclusions not supported by the evidence they cite. And, most importantly of all, I think it is a great example of how the people need to be protected from the medical community.

I should say that I have been on a nominally low-carb diet for about a year and a half now. I lost about 60 pounds in 6 months, and am now at a very maintainable 200. I don't eat steak for every meal and I don't mainline bacon fat. Basically, I eat lots of fish, meat, and green vegetables, and avoid sugar (except a moderate amount of fresh fruit), and I don't overindulge in bread or pasta. I find the diet to be very maintainable.

I've never found any other diet -- in the sense of "way of eating" -- that let me lose weight without being miserable. I react very noticeably to the presence of sugar or starches in my diet -- I get lots of energy, and then I get sleepy. In other words, I seem to be the sort of "Syndrome X" type Gary Taubes described in his New York Times Magazine article What If It's All a Big Fat Lie?"

The interesting thing is, I'm sure a low carb diet isn't for everyone. I know people that can eat pasta until they're blue in the face but never gain weight. We may be one species, but we each have individual and unique metabolisms. I have no doubt that an Atkins-like diet would be a pure disaster for some folks. I think we all need to find our own way of eating.

There are plenty of criticisms one can make of low carb diets, not the least of which is that it is reaching the point where it is ubiquitous enough in our society to be annoying, just like vegetarianism.

When I tried to eat vegetarian -- and I've tried several times -- I found I gained weight dramatically. Should I publish a press release saying "Vegetarian diets make you fat?" No. You can't look at a single data point and deduce a trend. The people at the Physicians Committee for Responsible Medicine, which some claim is a front group for PETA (not that that should affect how we evaluate their claims) are presumably trained in the scientific method, and know this. So when I see the Director of PCRM making statements that say, in effect, "Dr. Atkins died obese, therefore the diet he promoted doesn't work," I can only assume they are being deliberately deceptive, rather than just ignorant.

It's even more galling because it is a selective presentation of the evidence. Yes, we can believe from the medical records that Atkins weighed 258 pounds (which, incidentally, is about what I weighed when I started my diet) when he died, yet the same records show that when he was admitted to the hospital after his fall, he weighed 195. Furthermore, my sources indicate that PCRM Director Neal Barnard actually was a key aide to President Bush during the run-up to the Iraq war, and helped evaluate the evidence as to whether Iraq had weapons of mass destruction, (note: I am lying) so his cherry-picking only that evidence which supports his ideological axe is par for the course. (
Update, via boing boing: Does this man look obese to you?)

Edema -- outrageous swelling -- is common in trauma cases. You hear people that have seen loved ones die with edema say that near the end they couldn't even recognize the victim. It is a horrific thing to see, and I hope that none of you ever have to see it. Imagine that this happened to someone you loved. Imagine that you had to watch their face inflate like a balloon as they slipped towards death.

Now imagine that, after they died, someone used that condition to score ideological points. There is a word in English for that sort of behavior. That word is "despicable".

But this isn't really what I wanted to talk to you about today. What I wanted to talk to you about was privacy.

Every time I go to the goddamn doctor, they hand me a goddamn piece of paper which purports to explain how they are in compliance with the Health Insurance Portablity and Accountability Act of 1996 (aka HIPAA), which is the fake law the government passed to pretend to protect the privacy of my medical records.

About once a month, we see some famous person's medical records exposed in the media. This time it's Dr. Atkins' turn. As near as I can tell, no one cares that his privacy was violated. If the medical community is this cavalier about violating the rights of people with enough money and power to sue them, I can only assume that they won't even pretend to care about my rights.

PCRM is against laboratory experiments on animals, but they're perfectly OK with fucking a corpse.

Put aside the issue of criminal culpability. Put aside the issue of civil liability. Director Barnard, don't you have an ethical responsibility to not disclose materials obtained in violation of a patient's privacy? And I don't mean what your state's medical licensing board requires. I mean a personal ethical responsibility.

Director Barnhard, I hope that, someday, you develop enough ethical consciousness to feel ashamed that you fucked a corpse.