The Big Guns Who Fight for Big Pharma

With the activities of the American Diabetes Association, the American Association of Clinical Endocrinologists, and the Academy of Nutrition and Dietetics, what is a person with type 2 diabetes to think and do? With statements from Dr. Ratner about the dangers of some oral medications, “The data are inconclusive,” said Dr. Robert Ratner, chief scientific and medical officer of the American Diabetes Association. He said even if there were some excess risk, it would be “exceptionally low.””

This is the same Dr. Robert Ratner, chief scientific and medical officer for the ADA that says, “Many people with type 2 diabetes who are on medications don't need to do home glucose monitoring at all," in talking about oral medications. Outside his obtuse statements, I will give him credit for avoiding in general any acknowledgment of his other financial interests or conflicts of interest. These I am concerned about because of his constant criticism of anyone that may cause harm to corporate sponsors of the ADA and their medications. I can only guess that they have approached meter manufacturers and been turned down and therefore his statement about glucose testing.

I post his picture so that everyone can recognize him. Read this about Dr. Ratner.

 

The major author of the AACE Diabetes Algorithm is Alan J. Garber, M.D., Ph.D., Professor of Medicine, Biochemistry & Molecular Biology, and Molecular & Cellular Biology at Baylor College of Medicine, Houston, Texas. He is the 2013-2014 AACE Immediate Past President, 2013-2014 American College of Endocrinology Chancellor.

I post his picture so that everyone can recognize him. Read this about Dr. Garber.

These are two of the big guns in the promotion of oral medications for type 2 diabetes and both promote oral medications over insulin for people with type 2 diabetes. Dr. Garber was the author of this article or study if you must that appeared in ADA Diabetes Care section. It is fully supportive of the diabetes drugs, minimizes the risks involved, and covers mainly Byetta and Victoza.

Both of these doctors seem to avoid having to disclose conflicts of interest and just list prior jobs they have held in the academic world. They are both very vocal about how little needs to be done for people with type 2 diabetes. This is upsetting to me.

Doctors Leaving the System for Contract Medicine

These three doctors are thinking much alike and yet making themselves very different as they have moved to much the same degree out of the system. These are the doctors: Dr. Jordan Grumet, an Internal Medicine physician practicing in Highland Park, Illinois who has blogged since before 2008; Dr. Leslie Kernisan, practicing geriatrician in San Francisco and blogger since September 2012; and Dr. Rob Lamberts, a primary care physician in Augusta, Georgia who has blogged since March 2007 with a year off during 2011.

All three doctors have left the normal practice system and are using contract medicine as their norm. Dr. Grumet is the only one still with Medicare and insurance and the other two have left Medicare and insurance for fees only. Dr. Grumet uses the term concierge and Drs. Kernisan and Lamberts do not. I have listed the blogs by each doctor that I am using for my blog. These are what makes me enjoy reading them.

Dr. Kernisan can take criticism and the NY Times article did bring it on her. I can often disagree with any of the three doctors, but I still respect what they are doing and their objectives for what they wish to accomplish. We need more doctors like this. They may be providing a way out of our broken health care system.

Dr. Lamberts is the one blogger I have read the longest and I will continue to follow his blogs. I am quoting this because it explains Dr. Lamberts, “My experience with the system shows that nobody pays you without expecting more in return. Then I’d just end up compromising to keep the money flowing, and that is a kind of relationship I just got out of. Instead, I am trying to do it the right way, keeping my focus on what is important: giving my patients the best care possible. It’s not been real exciting – there hasn’t been much to write about, spending my creative energy on a building system that will actually improve care, not hinder it. I’ve also had to pay much more attention to the little details: tracking where the money comes from and where it goes. I’m not real good at that, so it’s been a steep learning curve, but it’s given me a sense of control I’ve not had for a very long time.”

Dr. Kernisan is concerned about the elderly and about their caregivers and this is not something many doctors are willing to take on. I will quote a little from her blog, “This morning, I gave a talk to a group of family caregivers, at a retreat sponsored by Family Caregiver Alliance. We talked about what caregivers should know about the geriatric approach to care, and how they can learn more about medical care that is tailored to the needs of aging adults. We talked about delirium, and how caregivers can recognize it and get better help from clinicians.

We talked about participatory medicine -- they were all savvy, experienced caregivers but none had heard of the e-patient movement -- and the Beer's criteria, and then we got into how tech tools might help caregiving feel more manageable. (More on those in future posts!)

I loved every minute of it, doing this session with family caregivers. I can't wait to participate in more events with caregivers.”

Dr. Grumet has just recently started his conversion and while he takes responsibility for what he is doing, he is cautious at the same time. I will not quote as much from him, but what he says is powerful, “There is a certain feeling of disenfranchisement among those of us who were present during the infancy of healthcare social media. Before the days of twitter, the players were few, the interactions meaningful, and the main mechanism of change was a quaint self publishing tool called a weblog.”

It has been interesting that the three doctors are spread out from Georgia, to Illinois, and California. They have spread their wings and are now working to improve health care for their patients.

Finding Diabetes Info on the Internet – Part 2

Part 2 of 2 parts

How do you determine if an internet site has the right information and is not promoting a product or service? Often you will need to read into the site and do some exploring. Some sites that are selling a service may be just what you are looking for if they provide good information about what they are selling. Unfortunately, this is seldom the case.  Too often there is nothing but hype and this should drive you away from the site.

Here I will use a site to demonstrate what to be careful about. This site, as a whole, is a very informative site, but unless you have MODY diabetes or suspect that your child has MODY, you will need to be cautious. This site has good information about MODY and this link is very informative. However, I do not recommend considering the services offered by this site unless you cannot find a diabetes clinic that will consider a comparison diagnosis for your child less than six months of age or will not send a sample into a lab specializing in MODY testing.

First, your insurance may not cover the appointment and the costs can be very substantial compared to a diabetes clinic run by endocrinologists. Many will use this lab or other labs that are proficient in doing the MODY test analysis. Costs will be lower and you will normally receive faster results, if done by a diabetes clinic. Yes, there can be diabetes clinics that are not reliable, but the majority are and should be sought out first. Most primary care physicians do not know about MODY and you will receive a diagnosis of type 1 diabetes for a child less than six months of age. This may be a correct diagnosis, but generally not for this age range. Babies in this age range should always be MODY tested.

The last part of Edward Leigh's blog has many points that need to be considered and how you interpret them will depend on your knowledge of diabetes and how into research you may be or not be.

I will summarize a few of them in my words, but I encourage you to read them on your own. In general, when you visit a website, think about the following: (For #1 and #2 below, realize that many studies are behind what it termed a pay wall, and not available to the general public.)

#1. If you are reading a research article or study, is the researcher identified and if so, is he/she a professional or accredited authority on the subject? Unless the person is a member of an educational institution, a government affiliated agency, or a known research firm, then read with caution. Does the lead author identify him-/herself and make statements supported by the research or just their perspective? Is a correspondence author with an email address listed for the study?

#2. If an organization or institution is responsible for the information, is it reputable and recognized as an authority on the subject? Sometimes they do not provide evidence of the author's expertise, but you should be able tell by the organization or institution that they were properly vetted or supervised. Poor information can still be released because oversight committees fail to do their job.

#3. I am leaving the items in his blog to give a warning about much of the research and studies in the field of diabetes. The bulk of the research is discriminatory and excludes people over the age of 64 and under the age of 19. Yet it is the people over 64 and under 19 that consume most of the medications as over 50 percent alone are over the age of 64. Read my blog here and follow the links for confirmation of the percentages.

#4. There is much controversy about oral medications and the testing methods used because of this discrimination. Also, most of the rodent studies were done with young, healthy rodents and not older rodents. This is hiding some of the potential deadly side effects experienced by the elderly population when the drug is FDA approved. In addition, officers of the American Diabetes Association and the American Association of Clinical Endocrinologists are promoting oral medications and criticizing anyone finding fault with them. And we as patients only need to look at the lists of corporate sponsors of the two associations to see the conflicts of interest.

#5. Always be alert to see if the name, address, and phone numbers are listed. Occasionally an email address may be listed. Without these, the site may not be reliable.

There are other concerns and I will list a few – is the information slanted and saying it is the only reliable source – this is because a legitimate company or organization will never say this. Depending on the type of site, is the information reviewed and/or updated regularly? WebMD.com is an example, as is About.com.

Most reliable websites do offer a statement saying to talk to your doctor or healthcare provider if something may apply and the site is not for health advice. Others say that this is based on personal experience and you should discuss similar situations with you doctor. I use the following - "Please discuss medical problems with your doctor."

There are other items listed in the blog by Edward Leigh, MA and I urge you to read his blog. It is good information for reading and knowing what websites may have reliable disease information.

This is not a definitive guide, but I hope these two blogs help in some way, especially for those new to finding diabetes information on the internet.  I will end with this quote, “The USDA food pyramid isn’t about health. It’s about selling agricultural products.” ~ Mary Dan Eades, M.D., co-author “Protein Power” books.