E-mail debates of newsworthy topics.
Dec. 6 1997 3:30 AM



Dear Michael,


       OK, let's get past the insults. I accept: I am an overweight French teacher, trying desperately. Maybe I deserve your insults. In any case, I expected them after I read your book and saw the way you insult people right and left (mostly left). It's your style. Susan Powter "screams nonsense." You refer to Deepak Chopra's "perfectly silly book." Dean Ornish belongs in the category of "propaganda," "fanaticism," and mindless contradiction. Debra Waterhouse is "too ludicrous"; she's one of the "shysters," like all those who warn against yo-yo dieting. I'm actually flattered that you included me with Susie Orbach, whose work you also call "psychobabble." To be insulted by you is a compliment.
       But your insults may also be a sign that your work is not merely the impersonal science and honest medicine in which you wrap yourself. They indicate that what you're doing--what all of us, doctors, nutritionists, and French teachers, may do--with respect to obesity is more like religion or politics. But I'll get to that.
       First, I wonder if you would clarify a couple of things? You wrote: "[M]y book absolutely panned Redux [the diet drug recently implicated in heart-valve disease], saying it showed absolutely no merit over drugs already on the market." Yet on Page 247, you conclude your discussion of the drug by saying, "I don't think there's any cause for going on Redux unless you've tried phen/fen [sic] and have had no success." Is this what you call ABSOLUTELY panning a drug with ABSOLUTELY no merit over others?
       And what about fen/phen? Don't you enthusiastically recommend it? You write: "In one case I tried hard to make an obese friend in his 50s (meaning heart-attack range) try phen/fen to no avail. I gave him articles filled with glowing testimonials about the drugs. I told him it worked for me and he saw for himself the evidence on my own body. But nothing doing. He's a gourmet; food is an integral part of his life, and he wasn't going to give up any part of it."
       The "nothing doing" expresses your exasperation and disdain for your friend's decision. But of course, we know now, what many doctors suspected then, that these powerful metabolic substances, taken over long periods of time, at high doses, are dangerous to public health on a vast scale. If your friend had stupidly followed your advice, he would be at his doctor's right now, wondering if he had heart-valve disease. Instead, "Nothing doing." He's still eating well and living happily, healthy and obese. No thanks to you.
       Don't you sometimes worry, Michael, about giving people bad advice? Some of the recommendations in your book sound loopy, like the one urging people to take Metamucil every day to lose weight. But some sound positively dangerous, like advising them to take 25 milligrams of ephedrine three times a day, along with 200 milligrams of caffeine, despite recent FDA warnings. I mean, given your track record, and your fierce aversion to fat, how seriously should we take this? Don't you think a little modesty is in order, a drop of self-doubt? After all, there are so many studies out there, and contradictory opinions among doctors and nutritionists and diet specialists, that it is hard for anyone to know for sure the whole truth about America's obesity. Premium no nocari (first of all, do no harm).
       Doesn't this suggest that you dangerously underestimate the danger of drugs because you wildly overestimate the risk of obesity? Which was my whole point. For reasons more moral than medical, more political than scientific, you don't see the contradiction in treating obesity both as a chronic, epidemic disease and as a failure to exercise moral control. For you, what is chronic and immoral is vice. Obesity is the sin of sloth and the vice of gluttony. You write: "Gluttony and sloth ought once more to become things of which people are made to feel ashamed." You regret that society has moved away from its "traditional role" of keeping its members moral "by harnessing their fear of rejection or disapproval by other members of the group." Finally, you blame America's obesity on its decadent values, its "rampant self-indulgence and the various cults of victimization, self esteem and false tolerance." The terms in which you excoriate obesity echo those with which Gingrich excommunicates Democrats. To propose a political, moral agenda, to bring America back to its slim and moral self, is the underlying aim of your book.
       Under the guise of reporting scientific, medical truths, you are preaching gospel and declaring jihads against fat. Sententiously you proclaim, "I proclaim this book to be the first trade (popular press) book dealing with obesity as a national problem [your italics]." By which you mean a national political problem, requiring not only individual commitments to mass action but also, where necessary, government power to combat it. You feel some sympathy for Kelly Brownell's idea of taxing fat, foods "with little nutritional value." Even though you wouldn't go quite that far, since, given your politics, you "just don't like taxes." But like many illiberals on the right, you hate the taxing power of government but not its power to institute control. Don't you ever worry that all our freedoms are at risk when health becomes an ideological weapon wielded by the state and endorsed by religion to enforce moral visions?
       But, maybe this is just a lot of psychobabble. Whatta ya think, Michael?


P.S. By the way, I wrote Cigarettes Are Sublime in order to stop smoking, which I did four years ago. I'll send you a copy. You'll love to hate it.