Monday, August 12, 2019

Retrospective #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 in “Cowabunga, the ADA makes the turn”). So, if you’ve had enough of that, read their magazine. That’s what I was doing in the doctor’s waiting room the other day when I came across this dreadful advice in a feature called, “Mail Call: Ask the Experts.” It was in a 2011 issue of the ADA’s Diabetes Forecast.
The reader 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. (Whew?)
The ADA’s expert told the letter writer (and all readers of this, the ADA’s official outreach organ, intended to educate 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 was seven paragraphs describing in detail, by brand name, each of the classes of oral and injected diabetes prescription medications which were still available for her physician to prescribe as her disease “progresses” to becoming, ultimately, an insulin-dependent Type 2. That was it. Not a word about food choices, or carbohydrates. Just leave your diabetes care to your doctor and Big Pharma.
Of the magazine’s 80 pages, 28 pages (35%) were devoted to advertising, most of that for prescription meds. My observation is purely associative, though; it does not prove causation. Perhaps a randomized controlled trial might test the hypothesis that the expert advice given, and the 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 ADA rag would survive?
The primary mission of the ADA and Big Pharma is their mutual survival. They need to sell ads to Big Pharma. To prosper, they must keep the pharmaceutical companies and the doctors who write the prescriptions happy. And doctors need to keep the patient dependent on medications too. How else can your doctor keep you coming back, besides saying, “Eat less (of a low-fat, high-carb diet) and exercise more”? Especially since that dietary prescription doesn’t work! Come to think of it, the last thing my doctor asked me recently was, “Need any renewals?”
The ADA’s Diabetes Forecast magazine masthead 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 without specialized credentials. The ADA magazine’s Editor-in-Chief and Associate Editors all have medical or related credentials. They also have an editorial board, on which our “expert” serves.
The ADA’s “Our Mission” statement 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.” That sounds to me like I am not the first to rail and foment about their mission.
Perhaps this is simply the natural history of any non-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 with the ADA are similarly disturbing. I think the list of corporate donors to the ADA, at, will help you understand why I view any medical advice coming out of the ADA with the contempt I think it deserves.
The ADA’s RDs and CDEs, as I reported in “Cowabunga…” have made the turn. It remains now only for the ADA’s medical side to have a similar awakening. I am dubious that they will though, given where their “bread is buttered.”

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