Recently Canada’s premiers [equivalent to American Governors] all got together for their regular talks. Don’t ask me when they meet. I’m an American and can’t vote for them, so I don’t usually pay attention to the details of such things. Actually I wouldn’t remember anyway; I focus on important topics. *har har*
I only want to talk about one statement in the article. I feel the impetus to discuss the entire realm of social medicine, but that would be going down a rat hole. The statement is harmonizing guidelines for the treatment of chronic illnesses.
Yes, I’m saying this is a bad objective. In fact, I’m saying it’s pure folly. It will kill even more people off early.
“Pretty dramatic statements there John.”
“Can you explain what you mean by them?”
But do you really want to listen? Do you really want to think? Let’s begin with a startling statistic:
In the United States alone, nearly 90% of adult diabetics — more than 16 million adults aged 35 and older — have blood sugar, blood pressure, and cholesterol that are not treated effectively, meaning they do not meet widely accepted targets for healthy levels of blood sugar, blood pressure, and cholesterol. In Mexico, 99% of adult diabetics are not meeting those targets. The study, “Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys,” is published in the Bulletin of the World Health Organization’s March edition.
We have a 90% failure rate to achieve our objectives. Nine out of every ten diabetics is headed to an early grave. That’s about 7% of the entire population, and in Canada that means about 2 million people are not effectively treated for their diabetes.
“That’s a double negative. You can’t use double negatives.”
“Because it doesn’t work.”
The system is broken. Why do we want to strengthen a broken system?
“It’s not broken, John. Patients simply refuse to follow directions.”
Amazingly this is the same reason the USDA gives for the obesity epidemic.
“It’s not broken, John. People simply refuse to follow our guidelines.”
Let me tell you something. People are following orders, sorry, guidelines. I always did. But then, well, I stopped following them.
“But they weren’t working. Why should I do something that doesn’t work?”
“We can’t help you if you do not follow our directions.”
“I’ll try harder this time.”
Thirty two years later John is being wheeled into surgery, unable to see anything but the blood in his left eye. Sorry, I wish I followed directions a little better. Dang.
There is a group of people actually doing very well managing their diabetes. There are no statistics, but I estimate at least half are achieving the required objectives. It might even be as high as 90% success rate. Many blow these target numbers away. Mine do, usually:
A1C<-6.5%<-6.4% (best 5.6%)
What is this group and how do they do it? It is called the DOC or Diabetes Online Community. We discuss, debate, encourage, support, cheer, hold hands, love, and we help each other. If I have a question about anything, all I need to do is ask. I go to a forum, post the question and wait. Ten minutes later I have half a dozen experts giving me their opinions. Let’s be clear about my numbers. I set my own basal rates and I:C ratios. I basal tested intensively. I profiled my meals and titrated my doses. I adjusted my diet to a very high fat, low carb eating style to where my lipids look outstanding and my complications have halted, and I got my own blood pressure down to near normal. I tested tonight after exercise at 106/59. I’m almost 52 years old and have been diabetic for 37 years. Under doctors’ care I bested my A1C at 7.3%, ran high BP over 140/80, and my cholesterol sucked so bad I actually agreed to take a statin. I learned almost every technique I used from other diabetics, either directly or from a website such as a blog. My endo never heard of basal testing, doesn’t agree with high fat diets, and won’t even comment on my BP.
Actual conversation when I asked about better ways to set my basal rates:
Dr. John: “Linda [DE] has algorithms for setting basal rates.”
Linda:”Dr. John sets all basal rates.”
Spike: “Simply basal test. Basal rates should keep your basals flat without food, and the only way to do that is skip your meals and test.”
John: “That sounds too easy.”
Spike: “It’s very simple. I don’t understand why all doctors don’t do this.”
I know why; because they are resistant to change, stuck in their ways, and reliant on guidelines.
“These aren’t doctors. They don’t know what they’re talking about. It’s dangerous.”
“Yeah, I know.”
“Stay away from them.”
“Okay, so what do I do when I have a question?”
“Read our pamphlets.”
“What if it’s not in a pamphlet.”
“Call your diabetes educator.”
“What if it’s in the middle of the night?”
“It can wait until morning.”
“Can I call you?”
“I don’t take calls.”
You know, I make a half a dozen or so life and death decisions every day, and I don’t take days off. I have this ball and chain attached to me permanently, and I can’t live my life by carrying around a suitcase full of fucking pamphlets. Sorry, but I can’t. That fact is that under the current system, when things don’t work well people get frustrated and quit.
“You can’t quit. This is too serious.”
“Don’t you think if it’s so serious, you’d design a system of help where I could ask for assistance 24*7 where I could get advice relevant to me, where I could talk to someone matter-of-factly instead of being lectured to, where they would consider my own choices and not try to force me into a one-size-fits-all diet, insulin regimen, or exercise program?”
“We talk about those things at your annual check-up.”
“You talk about these things. I am only allowed to listen.”
“I can only spend 15 minutes with a patient.”
*Red Alert, John is about to go postal!*
We don’t need more pamphlets or courses or doctors visits or endo visits. What we need is 24×7 assistance whenever we need it, wherever we are, from someone who will accept our individual care plans, who will not berate us, cajole us, or lecture us but who will cheer us and make us feel good about what we are trying to do.
We are not getting this from our healthcare system, and anything that moves us further away from the support we need is a bad move, a very bad move.
Suck it up, healthcare policy makers and practitioners. Accept the fact that patients in the DOC do a far better job than you ever will. We are the true masters of this domain, and it’s time you listened to us! John’s recommendation? Prescribe a membership at a diabetes forum to every patient. Set an official target of 1,000 posts a year. Berate them if they fail!
An the answer to whether I will take a statin is still no!