LEGAL THREATS FROM EYE DOCTORS
Date: March 30, 1999
Topic: Legal threats from Craig Steinberg
Optometrist and Lawyer for Optometric Advocates Legal Group
4454 Van Nuys Blvd.
Sherman Oaks, CA 91403
Craig's email of March 11, 1999:
From: Craig Steinberg
Subject: Your Myopia Myth website
Dear Sir: Please be advised that the information you are disseminating through this web site, for the purposes of selling a product and/or service, are in violation of the California business and professions Code sections 17500 and 17508, and the provisions of the Federal Trade Commission's section on false and misleading advertising and, more specifically, their ban on unsupported representations to the public. Notwithstanding your assertion that the Internet provides for the "true freedom of speech,' such "freedom" is still limited to being truthful, accurate, and not misleading. Advertising that is not is NOT protected by the 1st Amendment. Both the State of California and the FTC have made it a crime, in California punishable by up to 1 year in jail, and a civil cause of action for promulgating the type of information you have published. In particular, but not inclusively, the folowing statements and/or inferences are not supported by generally accepted medical principles: "This child's vision is being destroyed by her eye doctor." "Constant focusing on close objects causes a pressure increase in the eye, resulting in an abnormal elongation of the eye." "Unfortunately, the eye is capable of continuing this lengthening process until it literally tears itself apart!" The entire last paragraph on the page myopia2.htm. "If distance or "minus power" glasses were being invented today, they would not be permitted on the market except in rare cases because their safety has never been proven." In reference to cataracts, macular degeneration, and glaucoma, "However, these eye diseases, like most diseases, are caused by poor health habits such as eating the wrong foods." In reference to a patient's doctor, "The information you get is more likely to be erroneous than correct. Your doctor's main interest is maximum income, not your health." This message is being sent to you to give you an opportunity now to either present substantiation of these claims and all the others you make, including credible evidence that your "Myopter" is both safe and effective, or to immediately withdraw the insupportable claims and accusations and the sale of the Myopter, before suit is filed to force its removal and recover damages and/or restitution as permitted by law.
Reply from Donald Rehm:
It is interesting that optometrists even have a legal group to defend what they do. Since you have sent a copy to the Optcom mailing list, I conclude that you have been asked to send me this email full of threats and attempted intimidation by one or more members of the Southern Council of Optometrists which maintains this private mailing list at www.optcom.com. I even received a copy of an email to you from optometrist Cliff Courtenay of Valdosta, GA with the words, "Thanks Craig, again!" Is he the instigator of this attack? Ironically, I tried to join that list recently to establish a line of communication but when they found out who I was, their initial welcome was quickly withdrawn. Why didn't you just ask me to provide more information about my claims? Wouldn't that have been the professional way?
To tell the truth, I recently decided I could be more effective by adopting a more professional stance. Some changes along that line have already been made to the website and more are coming. There are many ways of saying the same thing. To appease the skeptics, I have now added so many references that the site is starting to look like a scientific journal. This is not the kind of thing the public likes to wade through but they will just have to skip over what they don't want to read. My book, The Myopia Myth, contains several pages of such references but obviously many people, apparently like yourself, don't care to read the book. This is unfortunate because I can't put the entire book, with over 50 diagrams, on the Internet.
You mention "generally accepted medical principles" as if this is published in a book somewhere and has been shown to be the absolute truth. You know as well as everyone else that many things that are generally accepted are erroneous, but it's obviously easier to fall back on that old cliche' rather than debate the issues.
Let's look at the accusations in your letter. You state that it is erroneous to say that "constant focusing on close objects causes a pressure increase in the eye, resulting in an abnormal elongation of the eye." Are you really unaware of the vitreous transducer studies that were done by Francis Young, PhD, while Director of the Primate Research Center at Washington State University? You can refer to my revised website where I have posted a reference to this research. Briefly, he surgically inserted a transmitter into the vitreous of monkeys and measured up to a 50% increase in vitreous pressure during accommodation. How can you be ignorant of such pioneering and significant research? I devote a full page of my book to this one study.
You attack my claim that "the eye can continue this lengthening until it literally tears itself apart." Have you never heard of the retinal detachment that strikes high myopes frequently? Have you never heard the term "retinal TEAR"? I have added some clarification on my website about this also, but once again, I am absolutely astonished at your ignorance.
You also attack my claim that "the safety of minus glasses has never been proven." I am sure that many people besides myself would like you to cite the references to the research that proves that minus lenses do not accelerate the movement into myopia when used for close work and that they are therefore not harmful. I have certainly not heard of such research.
But here is the statement that nearly knocked me out of my chair. You claim I am in error when I say that "eye diseases such as cataract, glaucoma and macular degeneration are caused by poor health habits such as eating the wrong foods." Are you really unaware that millions of Americans are turning away from high-fat, high-cholesterol foods because these have been shown to cause atherosclerosis, cardiovascular disease, diabetes, cancer and many, many other diseases? There is no longer any disagreement among the leaders in this kind of research. Nathan Pritikin, who was (significantly) not a doctor and who lived in your own state of California, was the first to take this information to the public, in spite of strong opposition from the medical establishment. But such was his success in using the media and informing the public that the doctors were finally forced to acknowledge that he was right. In my own library I have books by Pritikin, Dean Ornish, John McDougall, Julian Whitaker, Raymond Kurzweil, Norman Ford, and more, all contributing to the now widespread public awareness of this. Have you not even heard of the Framingham heart studies?
The atherosclerotic clogging of our arteries is nearly universal in our society and even begins in children a few years old. The only people immune to it would seem to be vegetarians or near-vegetarians. According to your analysis then, this atherosclerosis which degrades the functioning of the entire body somehow leaves the eyes alone. I suggest you do a little reading and see how many researchers are pointing their fingers at diminished circulation to the eye as a major cause of macular degeneration and other problems. The term "age-related macular degeneration" was created by people who either don't know the facts or want the public to think this affliction is inevitable. As I say repeatedly, the easy money is in treatment, not prevention. A more appropriate term would be "diet-related macular degeneration."
I suggest you visit www.eyesite.ca, the website of the Canadian Ophthalmological Society where you will find the claim that reading in dim light does not affect the progression of myopia. Why don't you fire off a letter threatening them with a lawsuit if they do not remove this unfounded statement or provide proof that it is true? Or does it fall under your heading of "accepted medical principles"? Do you see what an obvious attempt you are making to silence only those things you don't want the public to hear?
With regard to the Myopter, this device was put on the market before the FDA started regulating devices. It therefore enjoys the same grandfather status as eyeglasses. I have corresponded with the FDA in the past and they have assured me that its marketing is perfectly legal. You express concern that the device may not be "effective." How refreshing it would have been if you had said, "This device sounds promising. How can I help arrange further testing?" But that isn't what this is about, is it? I suspect that your real concern (and the concern of those you are fronting for) is that it IS effective. I suspect you see it as a long-term threat to business profits and want it off the market.
In this regard, you will find about four pages of case histories in my book which document how the vision of young myopic children was IMPROVED with the device, as shown by refractive, not subjective, measurements. Once again, if you had taken the time to do your homework, you might be more credible.
As a further indication of how the world is changing, the very same information you find on my website, albeit without the theatrics, has been published as "The Truth About Nearsightedness" on pages 112 through 114 of the February/March, 1999 issue of the Townsend Letter for Doctors and Patients, a highly respected publication that is sent all over the world. I have received many phone calls thanking me for this article. Isn't it curious that Townsend doesn't share your frantic concern over publishing this kind of document?
My attorneys have assured me that my current website and all my other activities fully conform to the laws of the land. If you persist in further threats and unfounded accusations against me, tarnishing my reputation with rhetoric that is the product of your personal fantasies with no basis in fact, I am sure you will be hearing from them and get to know them personally.
For now, I will refrain from emailing this exchange of letters to all the TV stations, radio stations, and newspapers in your area of California. I will also refrain from sending it to everyone in your community with an email address. But if you choose to continue with these threats, my restraint will disappear quickly. I don't think you appreciate how the world has changed with the Internet. Truth can no longer be suppressed by those with the most money. It's a level playing field now and a whole new world. The fact that anyone can so easily shoot your entire letter full of holes is not something you will want to spread around. I fail to find one solitary thing in your letter that makes any sense.
In recent months, I have been "testing the water," perhaps a little antagonistically, to determine the best way to proceed in this new era of information. I have concluded that talking to eye doctors who have already established themselves in the business world is a waste of time. The make-up of my new mailing list will give you a clue of where I think important leadership can be found. I have gotten some good feedback from both optometric students and faculty. Our hope for the future is in teaching these young people not only about Myopia Prevention but also about ethics and their duty to aid, not exploit, the people they are supposed to be serving. A separate course subject of Myopia Prevention is essential to impress upon the students just how important this topic is to their educations. In the United States we are fortunate to have a strong optometric tradition. There are many dedicated and concerned individuals on the optometric faculties, some of whom I have met personally in past years. Most other countries are not so fortunate. The MD's are king of the hill and they will go to their graves fighting to defend the ridiculous hereditary theory of acquired myopia. Sadly, our optometric faculties are under pressure from several directions not to do anything that will threaten the status quo. I wouldn't be surprised if they feel their jobs depend on not straying too far from the dictated path. Some of these pressures are:
1) The optical companies contribute huge sums of money to pay for research, full-page ads in optometric journals, booths and other amenities at optometric conventions, etc. They conduct a subtle, well-thought-out subversion of academic freedom. Just go to the above-mentioned www.optcom.com, click on "sponsors" and see the optical companies that give financial support to this site. Click on the SECO link (Southern Educational Congress of Optometry) and see the long list of companies that are helping to pay for the "education" of these optometrists. Go to www.opted.org, the website of ASCO, the Association of Schools and Colleges of Optometry. Click on "Corporate Members" and look at the list of optical companies that are providing financial support. No one wants to antagonize any of these companies. This is what is called a "compromising situation."
2) Optometric schools must conform to the dictates of the universities to which they may belong, universities which are themselves ruled to a great extent by big business. Many university presidents spend a considerable amount of their time raising money in any way they can think of. They can't afford to alienate any potential donors from the business world. But who should have the responsibility of safeguarding the visual health of our children -- dedicated professionals who are taught the truth and how to apply it in an ethical fashion or those whose only concern is profits?
3) Peer pressure comes from practicing optometrists who do not want anything taught that conflicts with their own view of the world and the sale of their products and services. They don't want their customers asking questions. They won't tolerate anyone claiming they are doing anything wrong.
In this respect, I note with interest your website at www.visioncare.com. You sell optical products not just at your own place of business but to anyone you can attract to your website. Imagine for a moment if MD's opened drug stores in their offices and sold to the public at a big markup the very drugs they had prescribed a few minutes before, increasing their income by so doing. I doubt that this would be legal, but even if it is, isn't it highly unethical and a glaring conflict of interest? Wouldn't it promote overprescription and neglect of instruction in disease prevention? Aren't you and many others doing exactly the same thing? A doctor's office should be a place of learning -- a place to learn about your problem, what causes it, and how to prevent it or remove the cause. It should not be a merchandise mart.
I sympathize with those on the optometric faculties who are unhappy with the present state of affairs but have been powerless to change it. However, now that the truth is getting out to the public, I believe the attitude of these faculties should be, "Change is inevitable. If we do not change on our own initiative and educate these students in basic Myopia Prevention and their duty to the public, changes will be forced on us from outside in ways we will come to regret. Therefore, past restrictions on academic freedom will no longer be tolerated."
I have occasionally used the term "evil people" in some of my writings. I do not mean this in the religious sense. I use it to describe the people who don't care how much they hurt others as long as they benefit personally. Recently, the nation's tobacco company presidents were testifying before Congress, stating that tobacco was not addictive and that more research would be needed before we could state that tobacco caused any health problems. I remember thinking that these guys were neat and clean-shaven and dressed in gray business suits, but I was looking into the faces of evil. These people are no better than the lowest drug pusher hanging around a schoolyard. I see this kind of evil in nearly every field of human endeavor, including the eye care business. You are supporting this kind of behavior, whether you realize it or not. Most people are more concerned about a pimple on their nose than about a famine in Africa that kills a million people. Such is human nature.
Your letter makes clear for the optometric students, in a manner I couldn't do with my words alone, what a crude, vicious, corrupt, money-hungry, cutthroat and incompetent business they have chosen as their life's work, to be carried out under the guise of professionalism. The optometric students will learn more about what they face in the real world by reading this exchange of messages than from a year of classes. To prevent themselves from becoming a part of this disaster, they will have to examine their consciences and rededicate themselves daily to the often-ignored admonition, "First, do no harm." The optometrists out in the business world have joined with the optical companies to symbiotically feed at the trough of public ignorance and misery, just like the MD's and the drug companies do.
The optometric students of today should be working now on the image they will present to the public and the website they will use to help do this when they graduate. A rare example of a website created by a prevention-minded MD can be found at www.drmcdougall.com. I look forward eagerly to the day when I can provide a link on my website to such a prevention-oriented website created by a practicing optometrist. That will be an event to celebrate. Who will be the person who will claim that place in the history books? I will personally award this plaque in honor of the event: "The International Myopia Prevention Assn. Humanitarian Award, presented to xxxx, the first eye care professional in the world to fully integrate the concept of Myopia Prevention into his/her practice." Plaques with somewhat different wording will also be awarded to those who follow this pioneer.
If my optimism is misplaced, and I get no further positive feedback from students and faculty that changes are being made, I will have no choice but to give up on optometry, as I have given up on ophthalmology. I will then direct my full attention to further educating the public and assisting in the malpractice suits that will be unavoidable. These suits will not be brought by me; they will be brought by the victims. Let's imagine for a moment, Craig, using you as a convenient example, just how this would be done. The attorneys would place full page ads in your local newspapers, stating that a class action malpractice suit is being prepared against optometrist Craig Steinberg for willfully destroying the vision of children for the sake of profits. Anyone with a child who has obtained an eyeglass prescription from you is invited to come forward to determine if they qualify to participate. Of course, the more plaintiffs, the more money for the lawyers if they win. Imagine how this will look to your customers, family and friends. Even if you win, you lose your reputation. Even if the plaintiffs lose, I win, because I have that much more ammunition to use in my public education efforts. This is not a pretty thought. It is distasteful to me also, but it may be inevitable. And if the doctor's defense is going to be, "I never learned these things in school," then the schools can be made co-defendants.
I suggest that you tell the reactionary individuals who have gotten you to do their dirty work to speak for themselves in the future so we know where to direct our fire and whose names to post on the Internet.
I have a suggestion: All of us who have websites on vision care will link to each other. I will say, "Follow these links to see what the eye care establishment has to say about myopia." You will say, "Here is another viewpoint you should know about." That way the public will have access to the full range of ideas. Aren't they entitled to this before they decide on the treatment they prefer? I am quite willing to do this. How about you?
Craig, let me end this by saying I am trying very hard not to say anything libelous here. In fact, I have cleared this whole thing with several attorneys. On their suggestion I hereby advise you that your email is reproduced here under the fair use doctrine and everything in my reply is my own opinion. But you have made some serious accusations against me. You have accused me of both state and federal criminal behavior. You have threatened me with prison. You have made these accusations in an email which is hardly a private means of communication. I have every right to defend myself, and I can only do so by pointing out where you are wrong. My response has been quite moderate compared to what it might have been. My reason for making this dispute public is to deter others who may be thinking of attacking me also. At least, they need to get their facts straight. If they don't, they will be giving me reasons to initiate legal action against them. You can't go around making wild accusations and threats like this just because you have a law degree. It wouldn't surprise me if you get a few emails from people who read this and want you to know what they think about your attempt to control what they read. It may well be that you are a decent person who has been mislead by others. I will give you the benefit of the doubt and assume so until you prove otherwise.