Aug 14 2008

Ulterior Motives for Eating Disorders, Too

I had lunch today with a long-time friend, Mindy.  (No, of course that’s not her real name…) It’s been at least a year since we saw each other, and probably two since we had a long conversation.

My heart broke as I learned that her daughter, Lindsay (not her real name either) has, for lack of a better description, gone right off the deep end.  I’ve known Lindsay since she was only 11 or 12 — a bright, articulate and curious adolescent.  In more recent years, I knew Lindsay had developed eating disorders.  She is anorexic and bulimec, and is almost 18 years old.

Lindsay’s eating disorder is only one in a long list of problems she has acquired during the past few years.  She has abused drugs, has been in trouble with the law, and is dealing with some other mental health issues as well.

Her mom, Mindy, has struggled to do the right thing, but of course, as parents, we never really know if we are doing the right things by our children.  Mindy shared some aspects of how they have tried to help Lindsay.  Her findings sounded remarkably like some of the advice I share with you on occasion.  It bears repeating, with this different light.

At one point, Mindy contacted programs for girls with eating disorders.  There are at least four of them within 150 miles of where Mindy and Lindsay live. Some are day programs.  Others are residential programs.  Mindy contacted them all — in fact, visited them — and learned that each one happened to be exactly the program Lindsay needed!

At least, that’s what they each told her.  Each program was different, using different approaches to treatment, but according to the people who ran them (and, do I need to add, the people who would be paid by Mindy’s insurance if Lindsay attended their program?) each of their programs was just right.

This should sound vaguely familiar.  I’ve blogged before about doctors who advise us about treatments, but may have ulterior motives for their recommendations. My misdiagnosis odyssey was my first experience with this.  I accused my oncologist of insisting I begin chemo because it was the only way he could make money from me.

My friend Max was told he needed prostate surgery and he should undergo a minimally invasive procedure.  After studying options on the internet, he learned that an even less invasive, and less trying form of surgery using a robot might work even better.  So he asked his surgeon about it, and was told that NO, he certainly didn’t need to have the robotic surgery…. then learned later that the surgeon he was asking didn’t know how to do the robotic surgery.  Hmmmm…..

The literature is rife with examples of doctors making money, sometimes discreetly or even under the table, from the treatment recommendations they make.  Whether they are investors in specific medical device manufacturing companies (think artificial body parts) or drug prescriptions (think subsidies from pharma drug manufacturers) — the recommendations being made to you may have more to do with lining a professional’s pocket than your treatment success.

One disclaimer here — I do not believe a doctor would knowingly recommend a treatment that would harm you just to make money.  But, I do believe there are times when, all else being almost equal, the first consideration would be money, followed by your success or with little regard to the expense to you.

For example, if you had a history of knee pain, your doctor might recommend your knee be replaced today, even though therapy might help you for another year or two.  Of course, he wants to replace it using the brand that pays him a kickback fee.  But you don’t know that, nor does your insurance.  And don’t forget, most of these artificial joints have a shelf life — meaning — if you get one two years earlier than necessary, you will need a new one two years earlier, too.

It seems to be true enough in healthcare — whether we are talking about brain surgery or eating disorders — that we need to find someone who can help us consider the evidence much more objectively.  That means we either have to find someone who can help us with all the options, or — even preferably — someone who won’t handle any of the options.  In Max’s case, he was able to find a surgeon who did both the minimally invasive surgery AND the robot surgery.  He told Max the robot would serve him quite well.

And in Mindy’s case — she was able to find an advisor in anothor city who had no ties whatsoever to any of the available programs — one who knew all about the other programs in that 150 mile radius, and who was able make a recommendation based on that knowledge.  The advisor wasn’t in a position to benefit her own program, so she was able to make a more objective recommendation.

Let’s learn from both scenarios.  If you are in a position to need difficult, invasive or long term treatment, make sure you get at least a second opinion.  Then find someone who either can provide you with ALL the choices, or someone who doesn’t have a stake in ANY of the choices to help you get more objective advice before you make your final decision.

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