I’ve been reading books in the cottage industry of healthcare reform. As we do in our book Too Much Medicine, Not Enough Health, some attribute the healthcare crisis to overdiagnosis and overtreatment. One of these, Worried Sick by MD Nortin Hadler, unpacks the bad science in this unsavory stew.
Dr. Hadler’s discussion of type 2 diabetes returned my attention to that disease. Type 2 diabetes, you see, is at epidemic proportions causing more and more people to be brought under treatment with a wide variety of pharmaceuticals. Two things have accelerated what is in fact an epidemic of overtreatment. First, the criteria for type 2 diabetes as a diagnosis has been lowered over time, including the creation of the disease of pre-diabetes. Second, those diagnosed are not only treated to control their elevated blood sugars, they are also treated to prevent the conditions associated with elevated blood sugars.
These conditions include high blood pressure, risk of stroke, damage to blood vessels, kidneys, eyes, and nerves, and risk of heart attack. The drugs prescribed to lower blood sugars and to preemptively treat downstream effects have risks of their own. Among these are the depletion of nutrients vital to the body’s own mechanisms for preventing the downstream conditions in the first place.
More fundamentally, there’s plenty of evidence for a reasonable person to conclude that conventional treatment of type 2 diabetes is all wrong. For example, a classic study used in establishing the standards for the treatment of type 2 diabetes turns out to be a great example of what the late Dr. John Lee taught me about how researchers committed to a particular view of health and disease draw conclusions that aren’t supported by their own data.
The study was conducted in the UK. It followed several thousand relatively young people diagnosed with type 2 diabetes, people in their 40s and 50s. One group was given pharmaceutical therapy while another group was simply given nutritional counseling—but, it is important to emphasize, no drugs. After ten years, the two groups were compared regarding diagnostic parameters: fasting blood sugar, hemoglobin A1c, body weight, and insulin. They were also compared regarding actual health outcomes: heart attack, stroke, neuropathy and other diseases of the small blood vessels, death from any of these diabetes-related causes, and death from all causes.
What I saw when I looked at the diagnostic parameters was that the drug-treated group had better blood sugars and hemoglobin A1c, but gained more weight and had higher insulin levels. This latter might seem a good thing, but is not—excess insulin is a growth factor and is toxic to the cardiovascular system. Moreover, in each group the parameters got worse over time at the same rate. In other words, neither approach prevented the degenerative progress of the disease. Hardly a compelling story in favor of conventional treatment. The story was even worse when I looked at the health outcomes. There was virtually no difference between groups when it came to the actual health effects of type 2 diabetes using these two conventional approaches.
Again, this was considered a seminal study and guided therapeutic standards. In my opinion, those standards using drugs are not supported by the data and are no more effective than very limited dietary counseling. What these major, standard setting studies never do is compare one group under conventional therapy to a group that eats a hunter-gatherer diet of whole, clean foods, takes vitamin supplements to protect against the effects of elevated blood sugars, and takes reasonable amounts of both aerobic and strength exercise.
Among other reasons, this will never be done because, in actual practice, healthcare institutions are structurally incapable of taking that kind of non-invasive course. But they can prescribe drugs. And so they do.
I’ve spent some time looking at actual statistics and can tell you that over the last sixty years there has been a general and consistent rise in blood sugar in the United States. It certainly isn’t from a lack of treatment. In my opinion, it’s the result of three structural causes.
A few weeks ago I was talking to a friend about organic sugar. He noted that conventionally raised sugar cane is a pesticide-laden business and as a result type 2 diabetes among cane workers in Hawai’i is huge. One way or another we are all in the fields with those cane workers. Those chemicals that disrupt our energy metabolism, leading to elevated blood sugars among other things, is delivered to us in the food we eat and through the agricultural practices that are allowed to flourish. The resulting cornucopia of processed foods (whether organic or not) further disrupt our energy metabolism because of their anti-nutritional properties. Finally, who gets exposed to those chemicals and foods and how much they are exposed is very much determined by social inequities.
Don’t ever think that science isn’t political. A healthcare system that keeps itself busy treating people for type 2 diabetes, with treatments that have no significant effect on either the disruption itself nor on health outcomes generally while it systematically ignores the root cause of the problem is politics of the highest (or perhaps lowest) order.
