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Dear Colleagues: We SUCK!

I'm not saying we are wrong. In fact, we may all be right, about everything. But we are all right about disparate and seemingly-competing bits of the same, whole truth. The result is that nobody can see that whole truth.
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A difference, to be a difference, must make a difference.

-- Gertrude Stein

This is another open letter to my colleagues. This is to everyone devoted to health promotion, disease prevention, lifestyle medicine, and all manner of related clinical and public health practice:

We suck!

Don't get me wrong; I love you guys (well, most of you). And for that matter, I think reasonably well of myself (well, most of the time). This is not my subjective assessment. This verdict is courtesy of the stone, cold calculus of epidemiology. We suck -- on moldy lemon rinds and rotten eggs. (Note to vegan colleagues: Just double up on the lemon rinds.)

I'm not saying we are wrong. In fact, we may all be right, about everything. But we are all right about disparate and seemingly-competing bits of the same, whole truth. The result is that nobody can see that whole truth, in common with that proverbial elephant in the room. The bits are in the way. And speaking of elephants... well, that will have to wait a few paragraphs. Hold that thought.

We may ALL be right... about fat and carbs, sugar and fructose, grains and gluten, salt and meat and calories. But it doesn't matter.

Forgive me if this gets just a bit lugubrious, but it is what it is. Everyone who -- like me -- has devoted the past decades of their life to combating global trends in chronic diseases and obesity IS GOING TO DIE and leave behind a more massive global burden of chronic disease and obesity than we started with.

This is failure on such a colossal level, it's hard even to come up with an analogy. The best I can do is this: it's as if the race to the moon not only failed to land men on the moon but caused the moon to crash land into Manhattan.

As I said, we SUCK!

Seriously, folks -- what hope does any of us have of going gentle into that good night when our time comes? Rage, we will, at the dying of the light, and the dying of our hopes to have made any difference at all. We will have failed.

Sad, but true. Just look around.

But maybe something yet can be done about all this. And it brings us back to elephants.

Theodore Geisel was the real person populating the wild imagination of Dr. Seuss. Under the guise of whimsy, Geisel was often saying some very important things. I absolutely love the movie Avatar, but meaning no disrespect to James Cameron, the Lorax was a highly effective (and rather less costly) courier of much the same memo years prior. But many of Dr. Seuss' best messages were brought to us by an elephant. Horton the Elephant, to be exact.

Horton, famously, heard the Whos when no one else could.

Imagine if the Whos confronted that stark reality, and the prospect of being boiled in Beezle-Nut oil, by all calling out their specific, differing coordinates -- latitude and longitude -- at seemingly random and asynchronous times. The Whos would all be right, of course, but it wouldn't make a damn bit of difference. They would not be heard, their voices would all disperse into a murmuring static, and their dust-speck world would be deep fried by a marauding posse of sadistic forest creatures.

To make the critical difference at their time of great peril, the Whos had to see past their ownership of diverse patches of real estate, and attest to their shared ownership of the planet. Of course, that common ground in no way obviated their claims to those diverse patches. Every such claim might be perfectly legitimate. But they all needed to claim that common ground, and shout loud and clear, "We are here!" at the same time, for it to matter -- for them to be heard. The competing claims of varied terrain could follow, but first things first. And the first thing was that fundamental consensus, not its component parts.

We have such fundamental truths and consensus regarding health promotion, too. If we rallied around expressing what we know, and using what we know, we could add a lot of years to lives, and a lot of life to years. We could continue to go our separate ways, too, in pursuit of the answers we don't yet have. But we could come together to use what we already, reliably know.

Or not. If we are all too busy planting our flags in different places, the world may never hear about ground we have in common. And we will all have been right about some of it, or all of it, and it will not have mattered; because it will not have made a difference. We will have come, we will have cried out our one small piece of a much larger truth into the din and the relative deafness, and we will have gone. And the great big mess we all set out to fix at the hopeful start of our careers will be left behind, bigger than ever.

For the message of any one Who to matter, all Whos fist had to combine their voices. The Who's first had to get past differences to common ground, and attest to what they all shared. Maybe we do, too.

A cacophony of competing contentions, and the exploitations they invite, is part of what created the most ominous trends in modern public health. More such noise is unlikely to help us any.

I don't want to suck at what I do, and I certainly don't want to shuffle off this mortal coil and leave those behind dodging ever more slings and arrows of outrageous epidemiology. It's a selfish aspiration, but I am guessing I am not alone.

So let's try getting together; you'll find the invitation to common cause, and a common patch of ground, right here.

After all, if not now -- when? And if not us -- WHO?

-- fin

Director, Yale University Prevention Research Center; Griffin Hospital

Editor-in-Chief, Childhood Obesity