Thursday, June 25, 2009


At last -- I thought -- I’d gotten to the point where my diabetes regime was predictable, practical and effective. The doctor at the Valier Clinic hadn’t turned over for a while, the very strict pharmacist in Cut Bank had moved on, and all my statistics were normal and happy.

Then suddenly I was told that all my prescriptions were blocked until I scheduled an appointment with the doctor. The good a1c I’d had didn’t count.

Without my prescriptions -- though I take few pills -- my regime might crash and burn. But I really resented being pulled in and suspected it was a money-generating scheme for the clinic. Remember that I had worked “backstage” as a ward clerk with this clinic and knew that “benevolence” was not their middle name. Their first, middle and last names are all “PROFIT.” So, kicking and screaming, I went to the clinic this morning, belly-aching and making accusations and spreading paranoia on all sides like a flu virus. The others were much more docile, because that’s the way is in Valier. You’re docile or you’ve somehow got a grip on enough money and power to throw your weight around. This is so true that if you’re not docile, everyone assumes you’ve got some secret source of money and power even when you don’t.

But no one had told me not to eat, so I couldn’t have the blood workup that was the reason for me being there. And it was NOT the doctor who had called me in -- it was a state agency that had decided to “survey” the state’s diabetes cases through the doctors. I don’t know which state agency. I don’t know whether they were covertly checking for illicit drugs. I’m told Medicare will pay for it, a nice little raid on the public purse, but I’m not told how much the survey would cost or what the goals and parameters might be. Nothing has been in the newspaper.

Big Health Care doesn’t have their fingers on the pulse of this state, they have their two hands around the state’s throat. It’s a major industry. So why all the secrecy or did I just not see the stories or recognize them? Or was some Helena agency hiding from the Big Health Care forces? Diabetes is such a GREAT source of income: something everyone has, assumed to be all their fault, and that people themselves believe can be treated with pills alone. They pretend to diet and exercise, but who has time? Want sugar, take more pills. Anyway, the effectiveness of the diet and exercise is in the twenty years BEFORE the diabetes is diagnosable, so the motivation is just not there in the most crucial years. I predict that diabetes will become a bigger money-maker for the pharm industry that even AIDS or anxiety.

But now I’ll switch sides. How can we drum up support and education for the public’s own health care of their own bodies -- let alone the massive changes that need to be made in the restaurant business, the grocery business, the ag business, the insurance business -- even ignoring the growing conviction that diabetes and other things are caused by environmental pollution, plastics, and food processing chemicals, overuse of poisons -- without knowing any objective measurements?

After all, the state’s humanities people suddenly became convinced by a biz school faculty member that if they only knew how much money everyone made with arts and crafts, the legislature would come to its senses and fund a few basic things like orchestras and museums. Of course, that was before the economic infrastructure collapse, but I didn’t notice any change of heart on their part. Still, was the principle wrong? (I still think it was wrong for art, but maybe right for health. But isn’t art healthy?)

The clinic offers a support group now, but that’s not what I need. What I need is a source of unadulterated food. Another case of fiddling around on the edges of a problem instead of confronting it.

I’m aware that some diabetes assumptions have been shot down now that measurements and cellular knowledge is so much more precise and powerful than the previous equation of “sugar + insulin = health”. In its place is a complex of things that can go wrong with the cycle of metabolism from resistance in the cell itself to antibodies interfering both with the production of insulin and the nature of it. Now there is Diabetes I, people who produce no insulin because the Isles of Langerhans in their livers no longer function; Diabetes II which is more a matter of cell resistance; something called LADA which has to do with autoimmune phenomena; gestational diabetes which is triggered by pregnancy; and so on. The numbering idea stopped with Diabetes III which no one understood.

I learned something interesting, which is that when doctors are given information in conferences or journals, the study is now ranked from “this is only an idea with no evidence or research,” through “this has been studied but the results are not conclusive,” to “this has been studied well for a long time and the results seem convincing.” One of the hallmarks of science is that the case is NEVER closed. New theories and methods turn up new evidence all the time. The best doctors are the wisest in terms of the big picture, not the ones with the longest list of meds.

I did decide to have the blood panel. I don’t need to worry about illicit substances showing up -- not even nicotine. But I’ve been taking metformin for several years now. One is supposed to have regular blood panels for liver function, because research shows some livers can’t handle it for long. Oh, yeah. No one remembered that until now. Too much distracted by the ghastly consequences of diabetes: foot amputation, blindess, kidney damage and for many late middle-aged women, heart flutter that throws clots causing heart attacks and strokes. Too much fear. Not enough thought. I watch the consequences daily in the obits.

I don’t need threats from my doctor or the pharm industry. I beg my friends not to slosh Roundup all over their yards to get rid of weeds. They do it anyway. I know how the doctors feel.


prairie mary said...

Richard Wheeler suggests this article is relevant. I agree. Thanks, R.

Prairie Mary

prairie mary said...

This is another EXCELLENT review by Dr. Nuland, whom I respect very much.

Prairie Mary

Anonymous said...

Thank you for posting the New Yorker address. The superbly researched piece examines why health care is so costly in McAllen, Texas, which has the highest Medicare costs in the country. When all is said and done, it is because the doctors and hospitals there treat medicine as a milch cow, to be milked for all it is worth; a lucrative business rather than a calling. By contrast, the fabled Mayo Clinic is one of the cheapest places to get good care--because its doctors treat medicine as a calling.

The medical establishment itself is at the heart of this American tragedy, which Mary Scriver documents so well her own way.