Saturday, January 18, 2014

The Nutrition Debate #177: The ADA’s Helpful Advice?

Readers here are accustomed to me slamming the ADA for their type 2 diabetes treatment protocol (except when I am singing their praises as I did here in “Cowabunga, the ADA makes the turn”). So if you’ve had enough of that, go read their magazine. That’s what I was doing in the optometrist’s waiting room the other day when I came across this dreadful advice in a feature called, “Mail Call: Ask the Experts,” in a 2011 issue of the ADA’s Diabetes Forecast.

The reader (name withheld by the magazine: hmmm…) wrote that she had recently been having “morning” (fasting?) readings in the 150-180mg/dl range and “…I cannot get them down.” She wanted desperately to know what was happening and what she could do about it. She explained that she was already taking two types oral diabetes meds, metformin and glipizide, a sulfonylurea. The response came from ADA expert “Belinda Childs, ARNP, MN, BC-ADM, CDE.” Wow! (Whew?)

The ADA’s expert told the letter writer (and all the readers of this, the ADA’s official outreach organ, intended to convey helpful information and education to the type 2 diabetic population): “Type 2 diabetes is a progressive disease,” and “over time the body is less able to produce insulin. As your body’s needs change, additional treatments may be needed.”

Then, almost the entire balance of her reply to the letter writer (and the type 2 world “out there”) was seven paragraphs describing in detail by brand name each of the classes of oral and injected diabetes prescription medications which was still available for her physician to prescribe before she might “graduate” (to borrow the words of Tom Hanks' doctor) to becoming, ultimately, an insulin-dependent type 2. That was it. Not a word about food choices. Just leave your care to your doctor and big pharma. They (“your diabetes care team”) will “review all the options” and take care of you.

Of the magazine’s 80 pages, 28 pages (35%) were devoted to advertising, most of it for prescription meds. I must admit, though, that this observation is purely associative; it does not prove causation. Perhaps a randomized controlled trial might be in order to test the hypothesis that the expert advice given and the preponderance of medical advertising accepted has a direct relationship. How about publishing the magazine without any pharmaceutical advertising, with just content advocating medical treatment? As a control, publish an edition in which the content recommends that type 2 diabetes be treated by food choices alone, one edition with and one without big pharma ads. Do you think this rag would survive?

The primary mission of the ADA, as I perceive it, is its own survival. To fund operations, they need to sell advertising for the magazine and obtain tax-deductible contributions from industry. To prosper, they must keep the pharmaceutical companies and the doctors who write the scripts happy. In other words, they need to keep the patient dependent on medications. How else can your doctor keep you coming back if all he/she does is to tell you to eat less (of a low-fat, high-carb diet) and exercise more? You both know you don’t need to hear that 4 times a year, especially if you’re “non-compliant” (‘cause this “conventional” advice failed!). Come to think of it, the last thing my doctor asked me recently was, “Need any renewals?”

As I step back, and consider the mission of the ADA, it is obvious that the ADA’s advice is in perfect harmony with keeping the type 2 diabetic population “in the fold” and entrapped to a life of dependency on medications as the disease “progresses.” The patient who is compliant with his or her doctor’s advice, (given in full accord with the “standards of practice”), will become increasingly dependent on medications. And if “the effects of these drugs goes away,” as the “letter writer” worried, big pharma will come up with new and better medications, when the patents on the older ones run out.

The ADA’s Diabetes Forecast magazine masthead pretty much tells me the story of the ADA itself. There’s an MD in charge of “Medicine and Science” and an RN, MSN, in charge of “Health Care and Education.” Other than that, all the other ADA officers are MBAs, CPAs, or are without specialized credentials. The ADA magazine’s Editor-in-Chief and Associate Editors have medical or related credentials. The magazine does have an editorial board, on which our expert, Ms Childs, serves.

The ADA’s “Our Mission” statement (in the print edition), also on their masthead page, has 3 high-sounding but rather limp tenets, especially #3: “The American Diabetes Association recommends that consumers familiarize themselves with nutritional information about food products.” It sounds like I am not the first to rail and foment about their true mission.

 Perhaps this is simply the natural history of any on-profit organization. See, for example, the “Illustrated History of Heart Disease: 1825-2015” timeline on the Diet Heart Publishing website: “In 1948 the AHA reinvented itself as a fundraising organization.” The parallels are eerily similar, and similarly disturbing. Review this list of corporate donors to the ADA and I think you will understand why I view any advice coming out of the medical side of the ADA with the contempt I think it deserves. I hope you do too.
Notwithstanding this, I hold out hope, as I said in the beginning of this rant. The ADA’s RDs and CDEs, at least the ones who wrote these new dietary therapy guidelines, have “made the turn.” It remains now only for the ADA’s medical care side to have a similar awakening. I am very dubious that they will though, given where their “bread is buttered.”

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