A North Carolina man living with type 2 diabetes has filed a federal lawsuit against a state dietetics board that he claims censored his blog, the Diabetes Warrior. The board claims that since he isn't a licensed dietician, he shouldn't be allowed to offer online advice to fellow people with diabetes about what they should and shouldn't eat.
Diabetes blogger Steve Cooksey's story sounds familiar: the 51-year-old was diagnosed with type 2 in 2009 after being hospitalized for high blood sugar. At the time, he weighed more than 240 pounds, didn't exercise and ate poorly. Doing some reading about diabetes, Steve apparently quickly discovered he might not have to be on insulin for the rest of his life like his doctor told him, but rather he could adopt a low carb/high-fat diet — in some circles crystallized as the "Paleo Diet" or "caveman diet" — to manage his diabetes. That worked, and he began blogging about his success in 2010 while apparently weaning himself off insulin and medications.
Actually, that's not the whole tale. He wasn't just blogging, and sharing his story online as so many of us in the Diabetes Online Community do. Aside from setting up a free Dear Abby-style column on his blog to answer questions, he also started charging a "modest fee" for what he described as "diabetes support" or "lifestyle coaching."
So in addition to sharing opinions and offering emotional support related to healthy eating and living, he was also tweaking people's diets and creating personalized nutrition plans for their intake of calories, fats and carbs.
You, know... basically what licensed dieticians and nutritionists do after completing years of training.
One day, Steve decided to challenge what a local hospital diabetes services director was saying at a nutritional seminar for PWDs hosted at a local church. He apparently called this woman out, disagreeing with her claim that PWDs should eat a diet rich in whole-grain carbs and low in fat. Soon after, his work miraculously caught the eye of the North Carolina Board of Dietetics/Nutrition (NCBDN), and he got word that his web site and activity were under investigation following a complaint lodged about his "practicing dietetics without a license."
Without proper credentials, the officials claim, he shouldn't be developing, implementing and managing nutritional care systems and providing specific counseling. Not only was his paid life-coaching service to be shut down, but any exchange of private emails or telephone calls with his blog readers or friends was illegal, too. The board even reviewed Steve's site and took issue with some of the exchanges he was having with PWDs online:
• "Honestly, he needs to get off the 'carb up and shoot up' treatment plan";
• "Your friend must first and foremost obtain and maintain normal blood sugars";
• "maintaining NORMAL blood sugars will allow his body to heal";
• "Cut the carbs to 30g or less of TOTAL carbs per day and eating meats and veggies will
• "I do suggest that your friend eat as I do and exercise as best they can."
That's why this case has important implications for the entire Diabetes Online Community and beyond. Is anyone blogging about diabetes, diet, and healthy lifestyle issues at risk of censorship? Where do we draw the line between simply sharing our stories to possibly help others live better with their own diabetes or other health conditions, and actively "informing" or "advising"?
Steve took some of the content down — on his own volition — and stopped his paid counseling service, but he isn't leaving it at that.
On May 30, he filed a federal lawsuit against the state board, alleging First Amendment free speech violations. He's being represented by the Institute for Justice based in Arlington, VA, which describes itself as "the nation's premier libertarian public interest law firm." They've even made a video about his case (brace yourself before watching, if you have any thoughts on "obese, junk-food-scarfing couch potatoes" developing type 2 and then "reversing " their diagnosis simply by losing weight ...!)
Steve's been dubbed "the Caveman Blogger" in reference to how he ate and exercised like a caveman straight out of the Stone Ages in order to stay healthy. His case has gotten A LOT of press. In response, the NCBDN posted a statement titled "Setting the Record Straight." Ironically, their wording is anything but straightforward. The only thing clear is that the board dropped its charges against Steve.
Nevertheless, as someone who's read hundreds of legal briefs and court decisions in my previous life as a legal reporter (but not a lawyer himself), I'm a little worried about the legalese of all this and how it could impact what we do in the DOC. Our current laws are really outdated and haven't kept pace with the Internet Age, and that's my biggest worry...
The Institute representing Steve in his lawsuit says this case is about "(whether) the government can throw you in jail for offering advice on the Internet about what food people should buy at the grocery store?"
Apparently, the Institute says the First Amendment doesn't allow the government to ban people from sharing "ordinary advice" about diet, or scrub the Internet—from blogs to Facebook to Twitter—of speech the government does not like.
The 31-page lawsuit points to libraries and bookstores where shelves are filled with self-help books on diet, aimed at communicating specific information to readers. The same can be said for television shows and Internet discussion forums, all of which are totally unregulated.
Anyone can check out those materials and find details instructions on issues that impact their health, and the lawsuit claims that under the defendant's logic, someone could buy a book and adopt all the lessons but the same person isn't able to contact the author or host by email or phone and ask about applying those lessons to their own lives.
"That is an arbitrary, and hence fatally underinclusive, distinction," the suit says.
Personally, I'm a little worried that this could be a test case setting a legal standard about what health bloggers can do.
What does this mean for those of us who blog regularly about diabetes, for example, telling our own stories and letting people know what works or doesn't work for us? Or to a weekly Q&A column like our own Ask D'Mine?
On one hand, Steve seems to have a point. And why have the NC officials gone after him specifically, when there are so many other so-called "health coaches" out there (it's easy to purchase a certification for that online) who haven't been told to stop what they're doing?
If they're all providing nutritional advice, what's they key difference between a health coach and a licensed dietician or nutritionist?
According to at least one of Steve's compatriots, "A health coach is someone who teaches you how to have great relationships. This includes relationships with other people, with yourself, with food, with work, with fitness, etc." OK...
I'm not one to support anything resembling censorship. But at the same time, I'm very wary of snake oil salesmen or those who simply believe their way is the only way, across the board. I'm a big believer in the Your Diabetes May Vary mantra, and not the "this worked for me so you must embrace it, too" stance — something seems to be happening here with Mr. Diabetes Warrior.
Just one example from his site that bothers me: "For Type 2 Diabetics, controlling diabetes with diet is possible. EVERY person that follows this meal plan reduces drugs and insulin. Every single person... many wean off drugs and insulin completely."
Disclaimers about not being a doc or dietician aside, it still reads like someone spouting medical beliefs as fact that may or may not be supported by those licensed to know. I repeat: YDMV. What works for one person may not work for another.
This crosses a line, in my opinion.
But whether we agree or don't agree with Steve here in what he preaches, the grander scale of this First Amendment question is something every patient-blogger should be taking notice of. And that's not legal advice — it's simply an observation based on my own worries about how far this could go. Take that as you will.