Authentic Medicine #9: Paula Deen and Diabetes

Anyone else see the conflict of interest with Paula Deen pushing unhealthy food and then making money being a diabetes spokeswoman?
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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  32 comments for “Authentic Medicine #9: Paula Deen and Diabetes

  1. Dr Ralph Riddall Dobelbower
    March 6, 2012 at 10:32 pm

    I fail to see any ‘conflict of interest’. I love Paula and I love her approach to cooking. You only live once. You might as well enjoy it.

  2. March 2, 2012 at 1:17 pm

    Paula appears to be so ethically un-troubled by her huge ethical breach! (Or is it “breech”, like a whale does in the ocean?)

    It is relevant that her style cooking contributes greatly to obesity. It is also relevant that obese patients consumed, on average, $1500 more per person for health care in the USA in 2009 than those of Body Mass Index (BMI) 20-24.9.

    So, with the societal cost for obesity being $500 per American per year, since about 33% are obese ($1500 x .333 = $1500), Paula Deen has missed the chance to really do some societal good as a public figure, by meaningfully saying “Mea culpa”, and change her cooking and her ways.

    Paula’s actions are just so wrong on at least two levels:
    1) She reinforces the false belief that the answer to a medical problem usually lies at the bottom of a pill bottle. Millions of people watch her show. She could be an agent for positive change, if she revealed that cooking in her manner contributes to obesity and its related problems and costs. But that would require honesty, something that she is apparently lacking, as evidenced by her signing with Novo Nordisk.
    2) Her actions are a HUGE conflict of interest. These actions say that she does not believe that she needs to meaningfully change her cooking or her sedentary slob behavior, and she does not believe her role as a public figure gives her the moral responsibility to finally educate people about the consequences of cooking in the manner she has done. The idea of “comfort food” is a load of crap.

    I know obesity has many root causes, some psychological. However, her cooking pours gasoline on the “fire” of our obesity epidemic!

    At the end of the day, her style of cooking plus her endorsement of Novo Nordisk are analogous to an uncouth person passing gas in public, and then asking who caused the stink, while acting as if tbey did not do the deed!

  3. Suzanne Udeen
    February 29, 2012 at 2:12 pm

    The drug people are wrong and Paula is wrong. A pill will not cure diabetes.The drug company should not use a celebrity to push their meds. Paula can make a lot of money off the drug companies. But what good will the money do when she loses a limb, or eyesight, or dies. She should educate herself and the public. All the money in the world will not cure this sad disease.

  4. Andy Nish, MD
    February 29, 2012 at 9:29 am

    From a personal standpoint, and ultimately only we actually know whether we are swayed or “bought” by pharma, I totally agree with Doug and disagree with JR Hoffman. Hoffman implies that we have no integrity and do not put our patients’ interests first. I do take offense at that viewpoint, and yes it is “personal” when anyone tries to paint anyone else as a group with such a broad paintbrush. I always attempt to put myself in the place of “what would I want and how would I want to be treated if I were in the place of this patient”. I know that there are greedy and unscrupulous doctors out there, but there is no evidence that “doctors as a group can, and are, PROVABLY (sic) bought all the time, in precisely this way.” I would say that most of the doctors I know, personally and as a patient, are highly ethical people. It is an insult to our profession to take the crass, cynical viewpoint that Hoffman would have us swallow.

  5. Dr. Bill Ameen
    February 28, 2012 at 10:55 am

    Paula could regain our respect if she lost 50 lbs! The thing is, most of our obese diabetics are fairly poor and don’t follow her recipes….they fatten up from soda, McDonald’s, and the like. But she should renege before she winds up on her Hoveround (like the famous K-Paul in New Orleans, I’ve heard). Your other point, Doug, is very much on target as always: Doctors are always shown as the bad guys. We’re supposed to be like Jesuits, unlike politicians, whom everybody believes to be crooked. Our corporate suit just told us to remove any brochures from the lobby sponsored by Big Pharma because it could open the door to “unions advertising in our lobby” (I s— you not!). Maybe on the other hand suicide by Krispy Kreme bread pudding (after eating a Gus’ White Spot Burger) may be a good option to our future!!

  6. mamadoc
    February 27, 2012 at 7:25 pm

    Yeah, and I gave somebody Viagra once because some rep gave me a sandwich, oh yeah, and it put me in a trance. He was kind of cute. I give myself credit for better sense, even though the academicians and ivory towerists don’t. (Or maybe THEY don’t have any better sense). Paula Deen was selling a product. She didn’t hold a gun to anyone’s head and make them eat her cooking (didn’t have to, either). Now she’s selling another product. Ya’ll grow up.

    • DonS.
      February 29, 2012 at 2:35 pm

      I think the point of the discussion is that she (Deen) may be seen in a different light if SHE were spending her own money on drugs/treatments/research for the control of the disease she now has. Instead, she is taking a huge endorsement standing behind the drug company marketing the product. I would not be surprised to find out that she does not even pay for the drugs she uses…
      I say it is no different if big tobacco companies were paid as ‘spokespersons’ to market the drugs used to treat Cancer, which was proven to be a direct result of the use of their product. However, if my memory serves me right, they were required as a part of their settlement to pump huge amounts of money into research and development of Cancer treatment, because of the causal relationship between smoking and Cancer.
      Granted, it would be hard to argue that Ms. Deen’s recipes are a direct cause of someone developing diabetes, but, then again, it might be hard to argue that they are not…
      Again, I think the point is that Ms. Deen might be a better ‘poster patient’ for the disease if she were to be investing in R and D for diabetes treatment, and not taking lots of money to push a drug.

  7. JR Hoffman
    February 27, 2012 at 3:47 pm

    That’s a very nice little piece, persuasively presented. It’s a shame you had to ruin it by failing to recognize that doctors’ conflicts are exactly the same. OK, most docs don’t get as much as she does (although plenty do); but there’s overwhelming evidence that “gifts” lead to huge changes in behavior, in exactly the way big Pharma wants them to do (and to the clear detriment of our patients) … even when they’re “only” a pen or a pad.

    Of course this type of celebrity endorsement is scandalous … but it’s not as bad as (literally) millions of doctors violating (even if unconsciously) their promise to put the interests of their patients first. Blinding ourselves to the COI created when we take such “gifts” is one of the great threats to the integrity of our profession.

    It’s truly stunning how we can be so perceptive about someone else’s foibles, but not our own.

    • Doug Farrago
      February 27, 2012 at 4:02 pm

      I know, right? I used to give Premarin to men just because I happened to see a pen with the name on it. Once a drug rep put me in a trance and made me sign 7000 prescriptions for a drug I never used before. I am so gullible. Thanks for clueing me in on my own foibles. What would I do without an academian like yourself putting in my place? I am way too stupid to see what a marketing ploy is. That is why I never read anything anymore.

      Please.

      • JR Hoffman
        February 28, 2012 at 12:23 pm

        This is the classic “how dare you” reply. “How dare you — especially you, a snooty academic — suggest I would do this that or the other!” It’s too bad you need to take this so personally, when in fact it’s not personal at all; it is human nature to be swayed by the types of relationships that these “gifts” create, and many studies have proven that despite all our individual outrage that anyone could think we’re so ‘stupid,’ we are in fact (as a group) easily led by the nose. (Or maybe you believe it’s the drug companies, even though they seem to know shat they’re doing — as they are so enormously successful — that are really the stupid ones … given how much money they apparently WASTE giving us things that have no impact on our behavior …)

        Your reaction, btw, is highly unlikely to be any different than is Ms Deen’s — as she would surely also insist that she is only doing what she now knows to be right … how dare you suggest otherwise?

        I don’t take these ‘gifts’ not b/c I think I’m better than anyone else, but b/c I know I’m not; it is the nature of these relationships that makes us ALL change our behavior — in ways that have been proven over and over again — even though we prefer not to believe it. You can feel affronted however much you want, but the only way to avoid feeling beholden (even if only subconsciously) is to avoid the ‘gift’ in the first place.

        I hope this won’t once again make you feel personally attacked (although I suspect it will), but I stand by my observation that it’s much easier, and far less threatening, to see only the foibles of others.

        • Doug Farrago
          February 28, 2012 at 1:19 pm

          I guess I need to stop watching TV, too? Because that makes me write for drugs due to their commercials. The difference, if you took the time to look, is that Ms. Deen is getting paid millions to be a spokesperson. Not even close to the same as getting a pen. Humans can be swayed with prizes, talk, grants, friendship, etc. Not all humans are the same. Not all doctors are the same. Sorry, but I can’t be bought by talking to a drug rep and getting a cup of coffee by them (which I do a couple times a week at 3 PM). Come join me and I will show you.

          • JR Hoffman
            February 28, 2012 at 9:27 pm

            OK, I hear you — you can’t be bought. But since doctors as a group can, and are, PROVABLY bought all the time, in precisely this way — there’s endless evidence (as the drug companies understand better than anyone) that we do all sorts of indefensible prescribing in close relation to which and how many “trivial” gifts we take — we’ll all simply have to acknowledge that you are the sole exception to the rule. (It’s funny, though, isn’t it, that all the others, to a person, also proclaim “how dare you,” and insist that they too are special, and CAN’T BE BOUGHT … even though it’s hard to see how it’s mathematically possible that no one can be bought, and yet the entire group does just what the buyer wants!)

          • Doug Farrago
            February 29, 2012 at 5:34 am

            I agree that the ortho getting kickbacks or neurosurgeon getting royalties is a conflict of interest. I am a primary care doc and times have changed and you are citing old evidence. It just shows how you are clearly out of your element here. There are no more golf outings, amusement park rentals, football trips, etc. I agree this is a good thing. Right now there is less then a third of the number of drug reps than there was in early 2000’s. Most doctors don’t even see them anymore. Drug sampling is getting less common. The biggest change that has occurred since the studies you sort of mention is the advent of strict formularies. The way drugs are tiered it costs many patients more to get these newly promoted drugs. Patients will not go for the $50 copay and call back to the office almost every time looking for the cheaper drug. Even if they don’t call back then their insurance will send both the patient and I a letter pressuring for a change and they usually win. This is today’s reality. Give me a pen (which I don’t want, by the way) or smile at me pretty and it still doesn’t matter. I will ask the rep, however, what is the coverage on their drug? Is there any coupons to decrease the copay? Why should I use this drug over a proven generic, etc? For example, coumadin is cheap but is a pain in the ass to use and the advent of Pradaxa is a good thing. With no testing, the cost is equal. The problem is that it is BID which always sucks. A new drug is now out that is QD called Xarelto. I think this may be good for some people to know. My partners, who NEVER see reps, have no clue about these drugs. Was this information harmful for me to get from a rep? Or an ad? Probably not. Times have changed.

          • Kurt
            February 29, 2012 at 3:18 pm

            Go Doug go. Fact is the insurance companies allow what we can prescribe. A d–n pen or lunch ain’t gonna do it. I agree, the data the ITB’s (ivory tower bastard’s) quote is old hat. In the old days, I tried something new, if it gave undue side effects or there were coverage complaints, I never prescribed it again. (ie. Side-Effexor before reformulation for example) The clueless ones are the non-physician types who lurk here. Primary care is taking a beating and no one is going to go into it in the future. Oh, I tell folks if it’s advertised on T.V. ain’t gonna be on the $4.00 list at Wally World.
            At least the phosphodiesterase inhibitors are cheaper (and safer I.D. wise) than a whore on Washington St.

          • Vance
            March 2, 2012 at 7:37 pm

            Yes, the ITB is using ancient data from docs who really were on the take back when I was still in diapers, maybe a few here and there now who install $50K devices or something. Primary care docs are clearly not swayed by drug reps and their “gifts” anymore. If they were, the numbers of drug reps wouldn’t be falling like an octogenarian on an icy sidewalk.

            At my clinic, we stopped taking samples for a number of reasons, but the main reason is what Doug said, even if a drug works, when the freebies dry up, the patient can’t afford them and their insurance won’t cover them, so we bounce to a different generic drug anyway. Drug reps rarely RARELY influence how I prescribe, and when they do, it’s because of efficacy or side effect profile of the drug, not some gift.

            The “Gifts” I take from Pharma are food, and food only. IF they come to talk about their drug, they bring lunch, which is only fair, since I’m giving them time over my lunch break.

            Case in point: I recently got a sweet fried chicken dinner from the makers of a new anti-depressant called Viibryd. I have no idea if I spelled that right. Know why? because I’ve never written it before. You heard me, I’ve eaten the chicken, and delicious chicken it was, and have NEVER written a prescription for the drug. Why? Cost is high, insurance won’t cover it, and it doesn’t work any better than many SSRI’s that are generic and cheap. What then does it do? It has a better side-effect profile. I put that profile knowledge that I gained while destroying a pile of mashed potatoes and gravy away in my cholesterol-enhanced brain, for a rainy day. And guess what? Next time I have a person who can’t handle the sexual side effects of their Sertraline or Prozac or whatever, and have tried the other cheap alternatives, and are willing to pay a pricey co-pay for the Viibryd, I might just look it up so I know how to spell and prescribe it, and write them a prescription. THAT is tne non-ivory tower version of “gifts” from pharma now.

            And can repeat version after version of that story. I see many reps for drugs, and eat the bagels they bring, and I have NEVER prescribed their drug. One guy brings the best donuts we get, from a town an hour away, and I’ve prescribed his drug TWICE and both times only after I’d tried every generic alternative I could find.

            Hoffman: at some point since the free trips to Hawaii and golf outings and God knows what other awesome perks I missed out on back in the 70’s and 80’s when I was breast feeding, and wearing parachute pants, this gift-influencing doctors thing changed. Primary care docs can’t be bought. We young docs have also been trained to see past the “glossies” and we know what a p value is, and we know the difference between an absolute risk reduction and an average risk reduction, and we know how to calculate and employ a “Number Needed to Treat.” Pharma has shifted where they spend that money. Now it’s used on insanely expensive direct-to-consumer marketing

            I also question if that marketing works, but this is a different conversation altogether–it must or they wouldn’t do it, I guess. That said, I remember when the had a green butterfly pimping Lunesta on every other commercial break, but I’ve never written for it once, and have never had a patient ask for it, so I can’t help but wonder if that marketing works that well. But I digress.

            Ivory Towers are isolated, and get left behind from reality. Doug is right.

          • Vance
            March 2, 2012 at 7:40 pm

            Oops I said AVERAGE Risk Reduction up there. I meant RELATIVE Risk Reduction.

          • Doug Farrago
            March 3, 2012 at 9:23 am

            I do love that you are using the PJ logo as your avatar. Keep hope alive.

    • Mark
      February 29, 2012 at 3:06 pm

      “millions of doctors violating (even if unconsciously) their promise to put the interests of their patients first”…

      are you out of your mind? millions? Do you have any idea what primary care physicians have endured over the past few years in an attempt to provide good care for patients and stay in practice? Do you really think that all doctors are on the take? Maybe you ought to be looking at device rep relationships with certain subspecialty physicians… you are way off base and terribly outdated with your current impression of the influence and power of a drug rep in a typical primary care practice in 2012

  8. Dawn
    February 27, 2012 at 2:44 pm

    In a few years she’ll be making money advertising for a Hoveround when she loses her legs to her noncompliance!

  9. Susan Sanazaro
    February 27, 2012 at 1:30 pm

    Deen’s no different from most people with habit-related illnesses. Her actions represent an inconsistency of behavior and avowed belief — not unlike hospital staff who are so focused on patient satisfaction scores that they can never directly tell patients that meds alone are only a small part of controlling the long-term effects of diabetes and other chronic illnesses. These are conflicting goals (evidence-based medicine or cooking vs. customer satisfaction) but not a conflict of interest. Deen could become a formidable advocate for good diabetes management if she lost weight, changed her recipes, and gradually introduced the notion that injectable insulin or oral agents are just an adjunct to good self-care (diet and exercise). Wonder if that would be OK with Novo Nordisk. Her initial comments to the effect that it wasn’t necessary for her to change WHAT she eats, but just to eat LESS, aren’t too promising.

  10. big picture doc
    February 27, 2012 at 1:29 pm

    If you look in the drug literature for DM, it will say that the only thing that has been scientifically proven to prevent cardiovascular disease in diabetics is exercise. As far as drugs go, medical-grade cinnamon, gymnema, alpha lipoid acid, etc can work wonders in diabetics especially if you get them early. Patients get very excited about taking this kind of control if you can get them early in the game and they can see results. I tell them that I have an extremely strong family history of DM, but that I do the above and have no DM. We need to compassionately inform Paula that she can make some simple substitutes into her delicious recipes. As the ad for the yogurt says, a “swaportunity”. I’m sure that with our support, she can use her incredible creativity to make some great healthy food that she herself will enjoy. Hey, maybe if she gets her DM under control, she could use her celebrity status to get insurance companies to pay us docs who spend lots of time with our patients with no compensation.

  11. big picture doc
    February 27, 2012 at 1:25 pm

    If you look in the drug literature for DM, it will say that the only thing that has been scientifically proven to prevent cardiovascular disease in diabetics is exercise. As far as drugs go, medical-grade cinnamon, gymnema, alpha lipoid acid, etc can work wonders in diabetics especially if you get them early. Patients get very excited about taking this kind of control if you can get them early in the game and they can see results. I tell them that I have an extremely strong family history of DM, but that I do the above and have no DM. We need to compassionately inform Paula that she can make some simple substitutes into her delicious recipes. As the ad for the yogurt says, a “swaportunity”. I’m sure that with out support, she can use her incredible creativity to make some great healthy food that she herself will enjoy. Hey, maybe if she gets her DM under control, she could use her celebrity status to get insurance companies to pay us docs who spend lots of time with our patients with no compensation.

  12. February 27, 2012 at 12:57 pm

    I think it’s a conflict of interest. However, I also think the Prozac Knife (wow, could they have come up with anything more idiotic?) is a conflict of interest. Dr. Doug, you are the only ethical doctor I know, and make me wish I lived in Maine. My doctors’ offices are wallpapered with “information” on diseases, all sponsored by GSK etc. and all featuring advertising for their drug to “fix” that disease. If I ask my doctor about alternatives, they truthfully do not know of any — this was never covered at any point in their education or training. 98% of the physicians I have seen don’t even know what B vitamins do… and the FDA includes vitamins among substances which must contain disclaimers that they “are not intended to treat or cure disease”. WHAT? The DEFINITION of a vitamin is that it cures a disease, an avitaminosis.

    Until the medical industry is no longer bought and paid for by the pharmaceutical establishment, I will take everything my doctor tells me with a grain of salt, and I’m supposed to be watching my sodium intake.

  13. Pat Nagle
    February 27, 2012 at 11:58 am

    Heard at a meeting: My name’s Joe, and I little drinking problem: I can never drink just a little.

  14. Rose
    February 27, 2012 at 10:30 am

    I really had to think about this one, because to me it’s obvious she’s a food addict – addicted to carby, sugary, salty, fatty stuff. I think she’s in denial about the relationship she has with food (read: not a good one, and it’s literally killing her). To me, addiction = crazy irrational behavior. I’m with Steve on this one – We all got a little bit of crazy, it’s not worth the effort to go at her with pitchforks like an angry mob. I got stuff to do!

  15. steve
    February 27, 2012 at 9:00 am

    Our lives are loaded with conflicts of interest on a daily basis and this one is hardly significant. There would be chaos if we went after all the stuff like this.
    Lighten up, Doug.
    Steve

  16. James Gleaves, MD
    February 27, 2012 at 8:49 am

    It makes her just like all the other diabetics – non-compliant. She won’t escape. Sometimes we all serve as a bad example. With a lot of luck, maybe she won’t .

    The best always Doug
    Jim Gleaves

  17. February 27, 2012 at 8:29 am

    Opportunistic and ironic–but not conflict of interest. I think the conflict arises if she CONTINUES to push the fat/carb food that she has been pushing up to now.

    • Ashley Medina
      February 27, 2012 at 2:51 pm

      Exactly what I was thinking! If she were to publicly rescind her famous sugar-coated fried lard diet and advocate a healthy lifestyle, it would not be a conflict of interests in my opinion. In fact, it may be inspiring to those who have “let themselves go”, to see a woman so famous for living the epitome of an unhealthy lifestyle so drastically change her habits for the better. But she should choose her side- it is definitely a conflict of interests + exploiting her condition to continue to push the fat/sugar diet while acting as a diabetes spokeswoman.

  18. Priscilla Merrill
    February 27, 2012 at 6:15 am

    Let’s not forget about Wilford Brimley. Not a cook but not a healthy dude though he claimed to “eat right, exercise, and watch my shugger” so let’s bash the men a bit too! What holds her dress together in back? Islets of Longer Hands!

    • Rufa
      February 27, 2012 at 12:36 pm

      Wilford Brimley has Diabetus. It is a totally different disease.

      • Vance
        March 2, 2012 at 7:19 pm

        LOL DiabetUS. Not only is it a different disease, but he also has a new device that is helping him beat his debilitating condition- the insanely long mustache. It filters most of the food and makes it fall off the fork, thereby cutting intake by 80%. I think he patented it, but, damn, why didn’t I think of that?

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