The New England Journal of Medicine (NEJM) and the National Socialists (Nazis)

 by Michael Applebaum, MD, JD, FCLM

This rant is not as light as some others. It is a bit more serious.

Godwin's Law states, "As an online discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches one." (For a more complete discussion, go to http://en.wikipedia.org/wiki/Godwin's_law )

The longer the discussion, the older it is.

The NEJM did not take long to compare the sick care workers at Abu Ghraib to the Nazis.

Perhaps this is NEJM's nod to anti-aging medicine.

NEJM has had to admit to publishing some bad information. For examples, see:

http://www.healthwatch-uk.org/awardwinners/peterwilmshurst.html,

http://content.nejm.org/cgi/content/short/NEJMe068020,

http://www.lawsuitsearch.com/news/drugs/Medical_Journal_Corrects_Vioxx_Article.aspx and

http://www.hon.ch/News/HSN/535854.html

NEJM, perhaps a bit self-righteously, was quick to condemn the sick care workers as Nazis. Whether their behavior is worthy of that comparison is debatable.

But when NEJM had a chance to really "expose" sick care at its World War II best, it lost courage.

It is apparently tougher for NEJM to do something to help people (i.e., patients) than it is to engage in name-calling.

Then again, who really suffers when bad medical treatment is administered? Why the patients, of course.

And who benefits? Why the medical profession, of course. It gets paid to create the problem and then administer the new therapy in an attempt to fix the problem it caused in the first place.

Perhaps NEJM is just being a good servant of the profession.

The following text was submitted to the NEJM for publication. They chose not to publish it. Another bad decision, in my humble opinion.

In the July 29, 2004 issue of The New England Journal of Medicine, [i] psychiatrist Robert Lifton, suggestively placed the behavior of physicians at Abu Ghraib on a continuum in direct line with the Nazis who, “In addition to cruel medical experiments, many Nazi doctors, as part of military units, were directly involved in killing.” [ii]

This is a decidedly weak comparison.

When all is said and done, the number of sick care workers implicated at Abu Ghraib is likely to be small. In contrast, the Nazi killing machine was of substantial size, since, according to Dr. Lifton and NEJM, “many Nazi doctors…were directly involved in killing.” Also the quantity of those affected at Abu Ghraib was relatively small compared to the victims of the Nazi physicians. [iii]

Such an anemic comparison does not begin to approximate the true magnitude of harm that can be caused when a systemic policy emulates Nazi conduct. [iv]

If Dr. Lifton and NEJM feel a need to draw comparisons between the behavior of “many” involved in sick care and the Nazis, a much better place to look may be the weight loss advice the sick care industry provides to the public. [v]

“Killing” is defined as:

To deprive of life

Intended or apt to kill; fatal. [vi]

Thus, it can be reasonably inferred that shortening life or placing one in a position where life can be shortened is a form of “killing.”

Does Obesity or Overweight Kill?

If we believe what the sick care industry says, the answer has to be a definite “yes.”

These conditions [vii] which can result in morbidity, mortality and diminished quality of life are associated with overweight/obesity:

Diabetes

Cancer

Heart failure

Angina pectoris

Myocardial infarction

Coronary heart disease

Stroke [viii]

The Recommendations Of The Sick Care Industry

The sick care industry recommends weight loss for the overweight or obese.

Illustrative of what the sick care industry prescribes to the public, i.e., patients, de jure or de facto, as to the proper dietary intake for successful weight loss are the following:

This is from the Mayo Clinic: [ix]

To lose weight, talk to your doctor about setting these daily calorie (sic) goals:

This is from David L. Katz, MD [x] and Jorge Cruise: [xi]

This is from Harvard and eDiets [xiii]:

Counting Calories: Doing the Math

…Let’s say you’re a woman who is 5 feet, 2 inches tall and weighs 150 pounds, and you need to lose about 15 pounds to put you in a healthy weight range. If you multiply 150 by 15, you will get 2,250, which is the number of calories (sic) per day that you need in order to maintain your current weight (weight-maintenance calories (sic)). To lose weight, you will need to get below that total. For example, to lose one to two pounds a week—a rate that experts consider safe—your food consumption should provide 500–1,000 calories (sic) less than your total weight-maintenance calories (sic). If you need 2,250 calories (sic) a day to maintain your current weight, reduce your daily calories (sic) to 1,250–1,750. If you are sedentary, you will also need to build more activity into your day. In order to lose at least a pound a week, try to do at least 30 minutes of physical activity on most days, and reduce your daily calorie (sic) intake by at least 500 calories (sic). [xiv]

If we assume that recommended activity burns 300 Calories/day, we end up with the following daily Calorie intakes to sustain the body:

Mayo:

Katz and Cruise:

Harvard and eDiets (150 pound woman example): 950–1,450 Calories.

How do these numbers compare to Dr. Lifton’s and NEJM’s Nazis?

In September, 1944, the internees at Dachau were fed 1,071 Calories daily. [xv] This is almost 20% more Calories than Mayo, Harvard and eDiets recommend for some women, about the same as Mayo recommends for some men and merely 7% less than Katz and Cruise recommend for men and women up to 200 pounds. [xvi]

And these expert diet representatives of the sick care industry expect people to eat this way voluntarily.

Fat chance.

Because the sick care establishment cannot forcibly ensure compliance with its Draconian, industry-wide Dachau Diet Plan, people quit.

“[U]nder the conditions of ruthless control of Nazi occupation” the inhabitants of the Western Netherlands were brought “to a state of starvation.” [xvii] The daily caloric intake of these starving, sedentary Hollanders was a relatively generous 1529 Calories in 1944. [xviii]

When competent researchers wanted to intentionally starve people, they fed male subjects weighing an average of 152.6 pounds a “whopping” 1570 calories on average per day. [xix]

Sick care industry experts blame dieters for the failure, "’Everybody can lose weight,’ said Dr. George Blackburn, a Harvard Medical School nutrition expert familiar with the survey who also has consulted for Glaxo. If people failed in the past, ‘they didn't try long enough and effectively enough,’ he said.” [xx]

This is despite the observation that “the grumbling and grousing that are inevitably provoked when the energy intake is deficient to the extent of 15 – 20 per cent, to the apathy and dissolution of higher human qualities that come with severe starvation, there is a wide variety of psychological reactions to hunger, many of which are almost, of themselves, diagnostic of the level of calorie intake” [xxi] and the fact that some diets, e.g., the Mayo Clinic, expect dieters to reduce caloric intake by as much as 52% from the calculated BMR. [xxii] It should be remembered that BMR does not include energy spent performing activities of daily living. [xxiii] Therefore, the reduction from total daily caloric expenditure is greater – up to approximately 69%. [xxiv]

It may be of interest to note that even if dieters (understandably, wisely?) fail to engage in 300 Calories worth of daily activity, the experts’ numbers still represent inanition fare for many at a level comparable to or less than the starvation cuisine of the Western Netherlands under Nazi control. [xxv]

Some Results Of The Weight Loss Recommendations Of The Sick Care Industry

Failed dieting is not without its sequelae.

Once freed from the torture of starvation dieting, dieters tend to overeat. [xxvi]

This makes them even bigger and fatter than before.

It also maintains or increases their risk for developing the deadly conditions associated with overweight and obesity since increasing BMI is associated with increasing risk. [xxvii]

Therefore, it is no stretch to consider expert diet advice as not only the cause of diet failure, but a vehicle for killing, i.e., shortening life or placing one in a position where life can be shortened.

In other words, given the size of the sick care industry’s diet advice division(s), arguably “many…doctors are…involved in killing,” as are, arguably, other advice-givers.

Additionally, there are the concomitant suffering and diminished quality of life experienced by failed dieters who survive the diet advice of the sick care industry as they progress towards a possibly hastened death.

Failed dieting is considered among the indications for bariatric surgical intervention. [xxviii] In fact, SAGES [xxix] and ASBS [xxx] consider it a mandatory requirement. [xxxi] Bariatric surgery itself has long-term consequences, including “lifelong follow- up with nutritional counseling and biochemical surveillance.” [xxxii] Although beyond the scope of this article, an investigation into liability for “needless” surgery when impossible dieting was the treatment precedent, might be of interest. This exploration would include such discussions as whether: the prescriber of the impossible/starvation diet regimen is at fault, the surgeon may be at fault for operating on a patient who had not received appropriate pre-surgical diet advice, the institution is at fault for permitting “unnecessary” surgeries as matter of policy, etc. [xxxiii]

What To Do

Recommending what is essentially starvation dieting as the proper path to weight loss for the general public is plausibly a mistake. Such error likely contributes to diet failure and therefore continuing (and increasing) overweight/obesity and the consequential illnesses.

The severe diet approach currently recommended and described above is but one problem extant in the system. There are others. These include conflicting information, [xxxiv] failure to aggressively combat patently erroneous weight loss program claims, [xxxv] and a continued reliance on the flawed premise underlying the foundation of virtually all weight loss advice. [xxxvi]

Since there is a reasonable possibility that the diet advice of the experts from the sick care industry contributes substantially to the overweight/obesity epidemic, it is suggested that the industry reconsider its recommendations and the data underlying it.

Contemplating a moratorium on providing advice while undertaking this re-evaluation may be appropriate (and life-saving). Until such time as the system can be reviewed and corrected, it is possibly better for the sick care and weight loss industries to remain silent than to fulfill the behaviors described by Dr. Lifton and NEJM.