Carrie has posted what I believe needs to be a rallying call for us all.
It is time for us to call "bullshit" on the certainty that so many are peddling and ask some serious questions. After all, when we choose treatment or participate in treatment we're assuming that those offering services believe in them and that they have good reason. We're operating on faith that there is some basis, some grounding to a recommendation.
That's why it is so terrifying when we visit two different clinicians - sometimes even on the same team - and hear completely different things. How can we believe one and not the other? We're not shooting craps or buying a lottery ticket. We can't split the difference or use an average, here.
One of the goals I set for our 2011 F.E.A.S.T. conference was that we call out the fact that the "Map" is mostly uncharted. This was not just the usual statement of "the data suggest" this was us trying to convey to families the truly scary truth that so little is known and most of what we're offered is based on nothing but good intentions. To me this isn't a pessimistic view of research but a rallying call: we need to AT LEAST use what data we have to help guide us and we have to DEMAND more data and we have to HOLD ACCOUNTABLE those who resist that sort of questioning.
As much as I like to drone on about things like the data to support Family-Based Maudsley Treatment, for example, it is only great data as compared to the NOTHING ELSE out there. Same with CBT. I'm ready to harangue you any day of the week on the role of weight restoration but there's so little research to help guide that so even if I told you what the top ten clinics in the world are I would have to also tell you that no three of them do the same things when it comes to weight restoration. If there were clear answers it would stand to reason that the top clinics would agree on them, right?
And yet the biggest problem isn't the lack of clarity at the top, it is the fact that most patients don't get treatment guided by ANYTHING. That is why people like me are so frustrated and, yes, angry at the pushback against evidence. We're not trying to clean the slate, we're pointing out that the slate is largely empty.
I want to thank Carrie for raising her voice to tell the truth. I'm cheering.