February 19, 2008

Where's Our Apology?

Among the bigger news stories last week was the report about how Australian PM Kevin Rudd delivered a major apology to the Aborigine people for past governments' policy of taking their children away from them.

This got me imagining a scenario where Dr. John Buse, President of the American Diabetes Association, would step up to the podium and tell a roomful of reporters that he was there to apologize on the behalf of the ADA for condemning three generations of people with diabetes to lives filed with unnecessary complications and early deaths because of the ADA's aggressive advocacy of the high carbohydrate/low fat diet which makes it impossible for most people with diabetes to control their blood sugars.

In my fantasy, Dr. Buse would announce from now on the ADA would refuse to take money from companies whose primary products are high carbohydrate foods. He would add that the ADA was going to dedicate a large part of the millions of dollars contributed by friends and relatives of people with diabetes to the task of teaching doctors that cutting out the carbohydrates is a more powerful tool for lowering blood sugar than any drug on the market. He'd conclude by announcing that he was appointing Gary Taubes to head a new Expert Panel whose job would be to rewrite the ADA's position papers on diet and medication and that Dr. Richard K. Bernstein would be heading up a panel to rewrite the ADA's recommended blood sugar targets.

Ah, well. I'm not holding my breath. But today's news did carry an encouraging tidbit. As of October, Medicare has announced that it will no longer pay to treat a list of medical conditions caused by the negligence of hospitals and doctors!

Medicare Won't Pay Hospitals for Errors--AP

I have always wondered why doctors could get away with charging customers to fix conditions that resulted from their own incompetence. None of the rest of us can. Now it looks like Medicare may be able to change this. Not only will Medicare not pay for treating hospital-borne infections, sponges left in bodies, inappropriately used catheters, etc. but the hospitals and doctors will be forbidden from passing on the costs of treating these problems to patients. Private insurers are already following suit, and doctors may finally start washing their hands and counting the sponges as if people's lives depended on it--which they do. The report in my local paper explained that it wasn't until hospital administrators learned that these errors would cost them money that they got serious about eliminating them. Before Medicare announced this policy, the hospitals were earning an extra $100,000 per patient for each medical mistake.

On reading this, it struck me that it may, after all, be the bean counters who save us from bad medical treatment. Will it be Medicare that prohibits hospitals from putting people with diabetes on the high carbohydrate diets that make it impossible to control their blood sugar, now that there is evidence hospitalized patients recover more quickly and with fewer complications when their blood sugar is kept in the true normal range?

Right now doctors have no incentive to get their patients' blood sugars down. They earn money only when the patient comes into the office with a problem. Hospitals don't see people with diabetes until they have that heart attack, need dialysis, or have that amputation, all of which earn them good money, too.

So its up to the bean counters--the people who know what it costs to fund all that bad medical advice--to save us. And who knows, perhaps someday we people with diabetes will get our apology AND the kind of hospital and medical treatment that would help rather than hinder our search for health.


Anonymous said...

We can only hope and pray that someday we get that apology.
I also hope,as you,that the power of Medicare will result in less mistakes and a shift in thinking as to diet and treatment of diabetics.

Scott S said...

I think the best advice to follow is the rule of common sense. Obviously, carbs make blood glucose levels go up, therefore common sense dictates that minimizing carbs will help people with diabetes to manage blood glucose levels more effectively than any other method.

Although I would agree that the ADA should reverse its stance on low-carb diets, their steadfast adherence to the old, high-carb, low-fat diet suggests volumes about how unmovable the organization is.

Everyone with diabetes has grown tired of the mantra that our condition is controllable using the methods prescribed by the ADA. The bigger question is who appointed them to represent our interests? It is an organization of doctors, and they were self-appointed. Perhaps once patients realize this, they will be further along towards gaining the type of control which is all but impossible using the ADA methods!

Alcinda (Cindy) Moore said...

Wow! You do have an active imagination!! Good to hear you're not holding your breath!

RE: Medicare payments. For years the government groups(CMS/JCAHO) have been keeping track of errors and admissions due to inadequate follow up. Now they are finally going to do something! I am glad to see this! They've actually completely revamped the payment methodology, pushing more procedures to outpatient, cutting "weight" (kind of level of care, it's used to calculate the payment....#days X weight = payment), adjusting inpatient days, etc.

Peter Atwood said...

Maybe we'll get lucky and the head of the ADA will come down with diabetes, get horrible treatment and have to start facing facts. But I doubt any amount of reason or evidence would change these people's minds. After all, with this low fat dietary advice you're basically talking about a position of religious zealotry. Whenever there's a big emotional stake, not to mention huge financial investments, you'll never see it change.

Anonymous said...

I want an apology, too - from the USDA and Jane Brody. I owe them for putting me on the path to diabetes with their whole grain, low-fat nonsense. I have only managed to remain healthy because I was lucky enough to come across Gary Taubes. Had I not read Taubes back in 2002, I would probably be diabetic by now. As it is, my blood sugar is pretty stable, with only rare hypos if I am foolish enough to indulge in sugar.

Jenny said...

Well, at least it is the mission of the USDA to sell grain, so their advocacy of the high carb diet is understandable.

But when an organization takes money from the public using the claim that they are working for the interests of a group of people with an illness, and spends that money on programs to make them worse, that is criminal.

Brody was just writing up the information the health organizations told her. Taubes' background was that he had already investigated and written about fraudulent and/or incompetent scientists who had gotten a lot of public attention (Cold Fusion) so he had what they call "a prepared mind."

Anonymous said...

Point well taken, but ... many many people take the USDA seriously because the bureaucracy usually has an aura of reliability. (Even I tend to trust their nutrient database.) And a whole generation of people has taken Brody's advice because she writes for The New York Times, widely acknowledged to be a high quality newspaper. Doesn't that kind of power come with responsibility?

Maybe the ADA really is worse - I certainly don't waste any love on that organization - but I tend to think they all owe us an apology. Then again, Brody is so blind that when her own cholesterol goes up she can't even entertain the possibility that it's because of her grain-rich diet, so why would I expect her to ever see the truth?

Anonymous said...

here's news for an apology -coming from Dr. Bernstein regarding the ACCORD trial. Dr. Berstein says the weight gain from the ADA recommended high carbohydrate diet and the industrial doses of insulin causes an increase in mortality. This makes sense especially since the ADVANCE trai(with similar study design to accord) showed that lower sugars were better - note that ADVANCE didn't use the ADA diet. here's a good link: http://www.diabetesincontrol.com/results.php?storyarticle=5517

Jenny said...

Actually, from what I have read about the design of ADVANCE study, they were using high carb diets. The study was designed in 1999 when doctors believed low carb diets killed people with diabetes.

The main difference between the two studies is in which drugs they used.

ADVANCE used a sulfonylurea for blood sugar control (ensuring they ate a high carb diet other wise they'd hypo). Then they added ACE inhibitor.

There were NO beta blockers used. Most importantly, there were NO statins and fibrates given to control cholesterol and NO Avandia or Actos.

I think the difference in drug regimens is the explanation.

Dr. B is convinced that sulf drugs burn out beta cells and ruin control, and the data from this study may contradict that belief.