३ मे, २०१९

"In California, where doctors performed more than 82,000 diabetic amputations from 2011 to 2017, people who were black or Latino were more than twice as likely as non-Hispanic whites..."

"... to undergo amputations related to diabetes.... A 2014 study by UCLA researchers found that people with diabetes in poorer neighborhoods in Los Angeles County were twice as likely to have a foot or leg amputated than those in wealthier areas. The difference was more than tenfold in some parts of the county. Amputations are considered a 'mega-disparity' and dwarf nearly every other health disparity by race and ethnicity.... To begin with, people who are black or Latino are more at risk of diabetes than other groups... Then, among those with the disease, blacks and Latinos often get diagnosed after the disease has taken hold and have more complications, such as amputations..... The circumstances that give rise to amputations are complex and often intertwined: Patients may avoid doctors because their family and friends do, or clinics are too far away. Some may delay medical visits because they don’t trust doctors or have limited insurance. Even when they seek treatment, some find it difficult to take medication as directed, adhere to dietary restrictions or stay off an infected foot.... [Hospitals] have started limb preservation centers [but e]ven with a team of specialists... saving a limb often depends on patients coming in early rather than waiting until their foot has become dangerously infected. But because their sensation is dulled, they often don’t appreciate the danger. 'How do you get someone to come in if they don’t have pain?... They need the gift of pain.'"

From "Diabetic Amputations A ‘Shameful Metric’ Of Inadequate Care" (Kaiser Medical News).

१५७ टिप्पण्या:

traditionalguy म्हणाले...

Ah,ha. The Medically Trained Privilege. A new class to be oppressed and destroyed. That will help out, right.

PM म्हणाले...

As written, horrific.

Openidname म्हणाले...

All of the suggested explanations relate to different behavior by the patient -- but it's racism!

cubanbob म्हणाले...

Making a class issue where there isn't one. If one doesn't seek medical attention what is there to be done? Mandate that everyone must see a doctor? If one doesn't adhere to medical advice what is to be done? Mandate compliance? Blood sugar control for type 2 diabetes is doable with the medications available but the hard part is watching the carbs. It's basically a low-carb diet for life.

Bob Boyd म्हणाले...

Didn't Obama tell us doctors are just cutting those limbs off to make money.

Not Sure म्हणाले...

some find it difficult to take medication as directed

They'd find it easier to take medication if their doctors didn't also tell them to cut down on the Big Gulps.

Mike (MJB Wolf) म्हणाले...

So it’s not the fault of stupid people who ignore their symptoms until the best option left is amputation. Nope. It’s racist doctors (who in my experience are far more often Asian or Hispanic than “white”) just chopping off limbs. Just like Obama warned us in the ACA debates. Uh huh.

mccullough म्हणाले...

Still better off in the US than in Latin America or Subsaharan Africa.

The comparison isn’t to White Americans. White Americans are comparable to those in their ancestral lands (Germany, Ireland, England, Italy, etc).

Asians are comparable to those in their ancestral lands (China, Vietnam, Korea, Japan, etc).

Genetics and culture matter.

Robert Cook म्हणाले...

My father was a diabetic. He died of congestive heart failure a month shy of his 78th birthday, but it was indirectly related to his diabetes. He had all the toes of his left foot amputated, and then later, his lower right leg from just below the knee. On one of my visits home, (before his right lower leg was amputated), I accompanied my parents as he went to visit his doctor. Everyone in the waiting room, (half a dozen people, at least), like my dad, were on crutches and had some part of one of their feet bandaged where something had been removed.

Fernandinande म्हणाले...

"A seminal study of health literacy in two urban hospital outpatient populations (N=2659) found, for example, that 26% of patients did not understand information about when a next appointment was scheduled and 42% did not understand the directions for taking medicine on an empty stomach.2

Another found that half of insulin-dependent clinic patients with “inadequate” health literacy did not know the signs of high blood sugar, low blood sugar, or what to do about them.3

The US Department of Education’s 1993 National Adult Literacy Survey (NALS) documented very large race and class differences in success at performing comparably elementary reading and reasoning tasks in daily life."

Ignorance is Bliss म्हणाले...

...and have more complications, such as amputations...

Amputations are not a complication. They are a treatment. Generally a life (but not limb) saving one.

Robert Cook म्हणाले...

"Making a class issue where there isn't one. If one doesn't seek medical attention what is there to be done?"

Perhaps they don't seek medical attention because they can't afford to.

"So it’s not the fault of stupid people who ignore their symptoms until the best option left is amputation."

Why assume they're stupid when it may be because they cannot afford to see a doctor?

bagoh20 म्हणाले...

I know two Hispanics with this issue, and no Whites, but the two guys I know are constantly in risk of amputation simply becuase they refuse to do what their doctors prescribe. They won't change their diet, and they fail to take the medication regularly. This stuff is controllable, but it takes discipline.

Ignorance is Bliss म्हणाले...

Diabetic Amputations A 'Shameful Metric' Of Inadequate Self Care

FIFY

Tarrou म्हणाले...

I used to do medical transport, and a lot of my clients were diabetics headed to dialysis.I could always tell within a week who was going to make it and who wouldn't. If they miss appointments or cancel a lot, they're gonna die. If they eat junk food on the way to dialysis, they're gonna lose limbs and then die. I had one guy, amputated foot, amputated leg, last three fingers on each hand amputated. He was down to no feet, one leg and thumb/forefinger on his hands. Dude would polish off a value pack (24) of store-brand prepackaged cinnamon rolls every trip to dialysis. He didn't last long after that point.

bagoh20 म्हणाले...

"Why assume they're stupid when it may be because they cannot afford to see a doctor?"

The guys I know have doctors and insurance, so? Besides you don't need much doctoring. The ways to avoid amputation are widely known and they learn them on the first visit. Or you Google it.

Drago म्हणाले...

Leftists/LLR-leftists want every state to be like CA, so Drs in other states better get to Cuttin'!

Gilbert Pinfold म्हणाले...

Did Type 2 diabetes research at a major pharmaceutical firm in the mid-2000s. Clinical studies run in different geographic regions had astonishingly different results due to differences in demographic groups. Blacks, hispanics, and Pima indians all have significantly higher rates of diabetes than whites, in general (in the case of Pimas, off-the-chart rates). Likely due to genetic differences in response to carbohydrates in the diet (remember, Southwest US indians only got access to highly-refined grains and carbs ~150 years ago, vs thousands of years of a more spare diet). Responses to various types of anti-diabetes meds differed wildly between these groups. You need to tailor the medical and drug approach with racial differences in mind, which is a big no-no. But we'd all be better off cutting down on the carbs, and upping the protein and fat content of our diets. Remember, the vaunted "Food Pyramid" was not a creation of scientific knowledge, it came from George McGovern's senate committee staffers. Give a read to Gary Taube's "Why We Get Fat". It's spot on with the science and history.

mockturtle म्हणाले...

Compliance, or the lack thereof, is part of the problem. But, yes, Hispanics and Native Americans seem to have a higher genetic predisposition to diabetes than non-Hispanic whites.

tcrosse म्हणाले...

Cutting off limbs due to diabetes: bad.
Cutting off genitals due to gender dysphoria: good

अनामित म्हणाले...

Black people often pooled their food stamps. You would see hugely obese black women pushing carts of meat, often the fatty pork cuts to go farther. More calories means higher risk of diabetes. The government for decades fed this problem. The obese now children will develop their diabetes at even earlier ages. Government care, from birth to grave...

mockturtle म्हणाले...

Perhaps they don't seek medical attention because they can't afford to.

Cookie, you know very well just how silly that statement is. Here in AZ, the Native Americans have both the Indian Health Service and access to Medicaid [double dipping] and low-income blacks and Hispanics have Medicaid. Health care is more 'affordable' to the poor than it is to middle-income folks.

James K म्हणाले...

My father is 97 and has had Type 2 diabetes since his early 50s. He has all his limbs, and no obvious complications. He's always seen his doctors regularly and followed their advice. He would occasionally "cheat" with a dessert, but never overdid it. White privilege, I guess.

n.n म्हणाले...

Diabetic amputation is a shameful metric of poor dietary choices.

James K म्हणाले...

You would see hugely obese black women pushing carts of meat, often the fatty pork cuts to go farther. More calories means higher risk of diabetes.

As I understand it, it's not the fatty cuts of meat, it's the carb-laden junk food: Pizza, fries, bread, pancakes, etc.

अनामित म्हणाले...

Why are medical care providers supposed to be "ashamed" of patients' refusal to make the behavioral changes necessary to avoid Type 2 diabetes in the first place, or control it once it develops? Hey, it's fine to make the effort to educate "under-served" populations about the dangers of obesity, lack of exercise, and turbo-charged carb consumption, but is that really the problem - "they just don't know any better"? I'm astonished at how many of the nurses in my area are obese - are they uninformed and "under-served", medically?

Btw, if medical care providers are supposed to be "ashamed" of the disproportionate Type 2 diabetes rates and complications among blacks and Hispanics, are they also supposed to be "ashamed", say, of the shorter average lifespans of whites relative to Hispanics? What exactly are the criteria for properly feeling shame about somebody else's poor "lifestyle choices"?

Susan म्हणाले...

It would be interesting if they could separate out the high achieving, high income minorities and see if they had better outcomes. My guess would be that they would have.
Mostly because they are more likely to follow doctors orders and do the hard work of changing their diet and lifestyle so they get better.

BarrySanders20 म्हणाले...

Sorry to hear that family history, Robert Cook. If I understand how statistics work these days, this means you are more than twice as likely to be black or Latino than before, right?

Jaq म्हणाले...

Sorry to hear that family history, Robert Cook. If I understand how statistics work these days, this means you are more than twice as likely to be black of Latino than before, right?

It’s like quantum entanglement!

rcocean म्हणाले...

Hello? Large numbers of immigrants come into this country with medical problems and are used to a low standard of medical care. That's why the Hispanic rates are so high. And "Black" means not just African-Americans, but African immigrants.

That's why you see the gap.

Bay Area Guy म्हणाले...

If they would get rid of the racial angle, which distorts the medical angle, the medical professionals could maybe address the problem.

Christy म्हणाले...

I just lost a cousin with multiple amputations to diabetes. Whitest middle management guy you ever saw. One Christmas dinner he began to collapse on his way out to his car. I helped hold him upright while his wife brought the car around and he muttered to me that he couldn't stop eating chocolate.

I'd just been diagnosed with Type 2 myself and his horrifying example served me well. Eventually watching carbs, never eating carbs without a protein, and exercise led my doctor to declare me diabetes free. Strange locution because Google tells me no one is ever cured of diabetes, but there you have it.

rcocean म्हणाले...

Our cat is diabetic. We keep telling her to see the Vet. But she refused.

Nonapod म्हणाले...

Patients may avoid doctors because their family and friends do, or clinics are too far away. Some may delay medical visits because they don’t trust doctors or have limited insurance. Even when they seek treatment, some find it difficult to take medication as directed, adhere to dietary restrictions or stay off an infected foot

The lack of health coverage I understand.

But the other reasons just seem to boil down to bad thinking. It's not like it isn't well known that diabetes can lead to lose of limbs. It's a near certainty that people in these situations have had family members who've also had diabetes and most likely lost limbs due to negligence. And obviously it's not like they want to lose a limb. In many cases it just seems like an individual is denying reality. They're set in their ways and unwilling to take the necessary steps (changing their diet, stop smoking, losing weight ect.)

I suspect this is all linked to the general hopelessness of being poor. The reasons why poor people of any race or ethnicity choose instant gratification over delayed, disciplined behavior patterns is because they don't see their situation as ever improving no matter what they do. They'll always choose the simple pleasure of eating unhealthy, carb heavy food, or smoking or drinking too much over long term health due to hopelessness.

n.n म्हणाले...

Cutting off limbs due to diabetes: bad.
Cutting off genitals due to gender dysphoria: good


Cutting of limbs, heads, and life due to leisure, pleasure, convenience, stability, and GDP: social progress. A wicked shame.

अनामित म्हणाले...

Cook: Why assume they're stupid when it may be because they cannot afford to see a doctor?

What percentage of the study subjects from "poorer neighborhoods in Los Angeles County" aren't on Medicaid?

As mockturtle points out, that's just a silly and knee-jerk response. Fine, you can object to calling them "stupid", but the problem (as is the case in a lot of medicine) is compliance, not the moral failings of medical providers or society at large.

Ann Althouse म्हणाले...

"So it’s not the fault of stupid people who ignore their symptoms until the best option left is amputation. Nope. It’s racist doctors (who in my experience are far more often Asian or Hispanic than “white”) just chopping off limbs. Just like Obama warned us in the ACA debates. Uh huh."

The article NEVER says that the decision to amputate is more likely when the condition is the same, and it's pretty obvious that the differences are NOT about doctors treating nonwhites worse than whites. We're invited to feel energized and empathetic because of the different impact, but NO ONE is accused of racism in this article.

Bob Boyd म्हणाले...

A true entrepreneur would recognize an opportunity here and start selling little chocolate feet by the bag.

Fen म्हणाले...

The lack of health coverage I understand. But the other reasons just seem to boil down to bad thinking.

There is a correlation. Jordan Peterson makes the point better than me, but the short version is that poverty in America is primarily due to not making responsible choices, not delaying gratification, ie. being bad at Adulthood.

1) Buy a $3000 flatscreen now with no money down at 24.99% interest or
2) put aside that money to pay for health insurance

Decisions...

Robert Cook म्हणाले...

"Cookie, you know very well just how silly that statement is. Here in AZ, the Native Americans have both the Indian Health Service and access to Medicaid [double dipping] and low-income blacks and Hispanics have Medicaid. Health care is more 'affordable' to the poor than it is to middle-income folks."

I've known people on Medicaid due to having low income. The ones I have known did not get a free ride on their medical costs, any more than people with regular medical insurance do.

If you think all economically disadvantaged people in American have access to ample health care, you're mistaken.

Even people with some form of private or public insurance can lack adequate funds to cover expenses not paid by their insurance. The deductibles in my own insurance get higher each year. I can easily see people putting off seeking care because they can't even afford their deductibles or co-insurance, or because their insurer won't approve payment for treatment they need.

Medical bills remain a big cause of bankruptcies in America.

Ann Althouse म्हणाले...

The article is written carefully to avoid accusing nonwhites of just doing a worse job of taking care of themselves, but by doing that the differences look like they are basically economic. So it's another plea to care about economic disparities. You might not care that much if people have smaller houses or less money to spend on travel and entertainment, but these horrible amputations might make you see economic disparity in a different light.

Of course, in many other articles, we see efforts to make us care about economic disparity because it correlates to race. That's what's happening with this article too.

iowan2 म्हणाले...

It is not a poverty problem. The study singles out two cultures. Not socio-economic classes.
It will be hard to make improvements not being able to openly identify factors of intelligence, and then genetic pre disposition.

Fen म्हणाले...

but NO ONE is accused of racism in this article.

You can't fault them, it seems implied, even though it is not:

"Amputations are considered a 'mega-disparity' and dwarf nearly every other health disparity by race and ethnicity... people who are black or Latino... other groups... blacks and Latinos often get..."

Poke people with a hot stick for 40 years and they will flinch when they see someone with a stick-like object.

traditionalguy म्हणाले...

The verdict is that we need a huge new Federal Agency with its own new Headquarters bldg staffed with thousands of supervisory level Democrats that do nothing all day except jockey for raises and rewards for ordering and distributing a Billion dollar propaganda film. And add in its own police agency to arrest bad doctors. It will of course that need about billion rounds on 40cal ammo a year for training, and add the riot gear with machine guns and vests, and a few tanks, all to meet any resistance to government medical orders.

Jason म्हणाले...

As I understand it, it's not the fatty cuts of meat, it's the carb-laden junk food: Pizza, fries, bread, pancakes, etc.

I am LITERALLY JUST NOW prepping a syringe of insulin in an IHoP reading this. Lulzulzulzulzulz. :-)

mockturtle म्हणाले...

Angle-Dyne observes: I'm astonished at how many of the nurses in my area are obese - are they uninformed and "under-served", medically?

Yes. At a doctor's office yesterday I saw a series of videos in the waiting room about their weight loss program. Every woman on the staff was fat with the exception of one African-American [actually from Africa] provider. Some were morbidly obese. So, yeah. Lack of education is not the problem. I've also observed this in many other health care centers. Stress may be a factor and food is a form of self-medication.

Michael K म्हणाले...

Perhaps they don't seek medical attention because they can't afford to.

Lyndon Johnson and the Medicaid law wrecked a pretty good health care system for the poor. The big city hospitals that were mostly county owned and that served as teaching hospitals were a good, if spare, system that served the poor well. I spent many years training, then teaching at LA County. Medicaid was determined by Johnson and his people to"mainstream" the poor and so it would not pay for care that was provided by interns and residents. The County hospital was starved of resources, then the illegals flooded it.

I remember nice black ladies who would come to GYN clinic and have us work them up and when we told them they needed a hysterectomy, they would thank us and go to a little Medicaid mill hospital to have it done. They would tell us "We trust you boys at the County but I can have a semi-private room at Morningside Hospital."

Eventually, the system that took pretty good care of them was starved of funds and then the illegals arrived.

TheDopeFromHope म्हणाले...

Obama in August 2009: Doctors refuse to work with and monitor patients to lose weight, eat a better diet, address the diabetes because they get $30,000-50,000 to amputate and a pittance otherwise. It's all about the benjamins, doncha know.

mockturtle म्हणाले...

Per Fen: Poke people with a hot stick for 40 years and they will flinch when they see someone with a stick-like object.

Heh heh.

Michael K म्हणाले...

I see Cookie quotes Fauxcahontas on her fake bankruptcy study.

Cookie will never be happy until everything is free, like Venezuela.

Amy म्हणाले...

My husband recently had a cardiac procedure. It required many visits to health care providers, and balancing a complex regimen of medications. We are educated, motivated and compliant. Everything was successful and we are very pleased. However, many times throughout the process, as I took notes to absorbed the detailed instructions, I wondered how patients who are less educated, savvy, motivated or have poor English could possibly manage.
I observed health providers working very hard with people in those categories, and never saw dismissiveness or disrespect (I had a lot of time to observe).
I read this article and believe there are many factors contributing to this problem, most of which are beyond the health system's ability to control. "Old habits die hard" - it said, re the high simple-carb diet. Even at risk of losing parts of your own body? Apparently so. If people refuse to act in their own best interest, how can this be helped? Mandates and regulation will not do it.

Matt म्हणाले...

The amount of things people can blame race on is truly amazing. Would those black and brown people still be whole if they'd gone to doctors in Africa or Latin/Central America? If the answer is yes, then they should probably still be living there instead of here with all us white devils.

For people who always claim to be 'strong' 'proud' and 'independent' they really do an inordinate amount of bitching.

madAsHell म्हणाले...

Pizza, fries, bread, pancakes, etc.

Fried chicken and waffles.

Michael K म्हणाले...

Gilbert Pinfold's comment above is a nice summary of the situation.

Sebastian म्हणाले...

"The article is written carefully to avoid accusing nonwhites of just doing a worse job of taking care of themselves"

But of course, that is the issue. I recall reading an article in, I think, the NYT!, way back, when I still subscribed, about the shocking lack of self-care by people who were at dire risk of losing a limb.

But the article can't avoid the basic facts entirely -- they "find it difficult" etc.:

"Even when they seek treatment, some find it difficult to take medication as directed, adhere to dietary restrictions or stay off an infected foot.... [Hospitals] have started limb preservation centers [but e]ven with a team of specialists... saving a limb often depends on patients coming in early rather than waiting until their foot has become dangerously infected."

Which means that even making everything equal won't produce equality.

mockturtle म्हणाले...

Cookie, nearly every community has some kind of free clinic or income-adjusted access clinic. I volunteered in one in a fairly small town for several years. All of our physicians and other providers along with all the staff volunteered their time. You can lead a horse to water....

Jason म्हणाले...

Insulin prices are still a problem, even though the current gee-whiz versions of the drug have been out for decades and are out of patent, economies of scale have not been passed on to the consumer. These benefits get eaten up by the various rebates and incentives between the pharmacies, manufacturers, prescription benefit management companies and other various middlemen.

I've got insurance via my wife's employer - a big box retailer. I'm not on a big insulin dose and manage pretty well, but when I replace these two vials of insulin in my bag next to me, that's going to be $400 bucks or so out of pocket.

I am fortunate I make a lot more than your average big box retailer cashier. So I'll have that $400 bucks cash. But the girls I drive home when I pick my wife up from work at night because they missed their bus or can't afford to get their cars fixed don't have $400 lying around. So they'll skip it.

Diet's an even bigger part of it for Type 2s, but that doesn't make the structural cost problems of insulin distribution go away. The Walmart stuff is great, when it works ($26 per vial) but doesn't work for a lot of people. And nobody's compensated to push it. My doc never once mentioned it. I only know about it because I'm curious and read a lot all the time.

Jason म्हणाले...

Adding: Diet's an even bigger part of it for Type 2's, but Type 1's will need the insulin even with perfect diets.

gilbar म्हणाले...

I've said before, and i'll say again!

Stop this Racist disease!

effinayright म्हणाले...

nonapod said:

"I suspect this is all linked to the general hopelessness of being poor. The reasons why poor people of any race or ethnicity choose instant gratification over delayed, disciplined behavior patterns is because they don't see their situation as ever improving no matter what they do. They'll always choose the simple pleasure of eating unhealthy, carb heavy food, or smoking or drinking too much over long term health due to hopelessness."

*********************

What a crock. Are the poor in America equally as poor as those in Zimbabwe or Congo or South Africa?

Do the latter have a/c, big-screen TVs, cars and access to cheap electricity? No.

Fact is, American "poor" have all sorts of luxuries that very few in *this* country enjoyed 75 years ago.

A trillion dollars taken from the non-poor in taxes has been spent to make their lives more comfortable, and to lift them out of poverty. If any of them feel hopeless, it's largely because they are supported by government programs that teach them dependency rather than independence.

Michael K म्हणाले...

If people refuse to act in their own best interest, how can this be helped? Mandates and regulation will not do it.

My brother-in-law has had type II Diabetes for many years. He also weighed 350 pounds for years. His neuropathy was such that he once nailed his foot to the floor and did not notice until he started to walk away. My sister weighs about 120. He is a great guy but just ate too much. He would get up in the middle of the night and fix himself a sandwich.

They had no problem getting medical care.

Cookie wants Socialism but refuses to see where it leads. Obesity is epidemic in Hispanics. Go to a grocery store that caters to Hispanics and follow the 250 pound teenagers through the checkout line.

Sebastian म्हणाले...

"very large race and class differences in success at performing comparably elementary reading and reasoning tasks in daily life"

I seem to recall a set of studies that argued that variations in group well-being were strongly related to distributions of cognitive skill. Charles somebody.

Hypothesis: control for IQ and a lot of the race/class effect goes away.

Nonapod म्हणाले...

iowan2 said...
It is not a poverty problem


The article frames it as a "brutal injustice of American health care". And it goes on to say

"A 2014 study by UCLA researchers found that people with diabetes in poorer neighborhoods in Los Angeles County were twice as likely to have a foot or leg amputated than those in wealthier areas. The difference was more than tenfold in some parts of the county."

Basically, this is more likely to happen to poor people. I believe a large part of the reason these diabetic amputations occur can be directly linked to poverty.

Poor people are more likely to have trouble delaying gratification. Difficulty delaying gratification is one of the big reasons they're poor in the first place. But it also acts as sort of a postive feedback loop because they don't see the point in not indulging in simple pleasures, not spending whatever money they have foolishly, because they don't see how their situation can improve if they delay gratification. They lack hope. And people who lack hope are more likley to want live in the moment.

And, of course, poor people are more likely to have low quality or no health coverage.

Bob Boyd म्हणाले...

I'm envisioning little, foil-wrapped bites of chocolate shaped like toes.
Call them Hersheys Kisses-Type II.

To raise awareness.

Nonapod म्हणाले...

What a crock. Are the poor in America equally as poor as those in Zimbabwe or Congo or South Africa?

Do the latter have a/c, big-screen TVs, cars and access to cheap electricity? No.

Fact is, American "poor" have all sorts of luxuries that very few in *this* country enjoyed 75 years ago.

A trillion dollars taken from the non-poor in taxes has been spent to make their lives more comfortable, and to lift them out of poverty. If any of them feel hopeless, it's largely because they are supported by government programs that teach them dependency rather than independence.


I agree. Poor people are most certainly living better lives than any other time or place. But that doesn't mean they won't feel hopeless or they won't engage in self indulgent, personally destructive behaivor due to an inability to delay gratification.

And I agree that many of the Government programs do far more harm than good by keeping people dependent and encouraging self defeating behavior.

David53 म्हणाले...
ही टिप्पणी लेखकाना हलविली आहे.
Darkisland म्हणाले...


Blogger Jason said...

Insulin prices are still a problem, even though the current gee-whiz versions of the drug have been out for decades and are out of patent, economies of scale have not been passed on to the consumer

It doesn't get any press at all it seems but one of the things PDJT has done is have the FDA revise the generic drug approval process. This will, among other things, prevent pharmcos from extending exclusivity on drugs almost indefinitely.

It will take some time to filter through the systems but it will have a HUGE impact on things like the out of patent insulin you mention.

John Henry

gilbar म्हणाले...

I Love Pepsi, it's delicious, the only thing that's better is Mexican Pepsi (or new, Throughback Pepsi) with the Real Cane Sugar. When I was working, I used to drink 6 to 8 a day.

Last year, my glucose number was at 106 (should be <100) and i am Very Fat (+300lbs). My Doctor asked me if I was okay with needles (Knowing from experience that i HATE needles), because it "wouldn't be long before i'd need them"

So, I've reduced my Pepsi intake down to about 2, A WEEK. I've replaced them with unsweetened (not artificially sweetened), decaf green tea: Which tastes like CRAP.
I went in last week for my annual checkup, and my glucose was down to 97 (And, i've lost 15 pounds: now 314 lbs).

I'm still at risk from poking myself with sharp objects, but for now it's much more likely to be a fish hook (THIS is why you should use barbless hooks).


Hey Skipper म्हणाले...

@nanopod: I suspect this is all linked to the general hopelessness of being poor. The reasons why poor people of any race or ethnicity choose instant gratification over delayed, disciplined behavior patterns is because they don't see their situation as ever improving no matter what they do.

That has to be the most insightful thing I've read this year.

The Minnow Wrangler म्हणाले...

Hmmm diabetic education is not available in other languages? Is it possible that certain populations don't follow their doctors' instructions? But of course this is "racist" and "classist" LOL. Lock them up, restrict their diets, and make them exercise. That will fix everything.

Robert Cook: Medicaid patients, assuming they can find a doctor to treat them, have no costs at all to themselves for medical appointments or prescriptions.

However, doctors being inadequately compensated by Medicaid, are not always willing to take on new Medicaid patients.

Fernandinande म्हणाले...

I'm envisioning little, foil-wrapped bites of chocolate shaped like toes.

With Fritos on them, representing diseased toenails.

cubanbob म्हणाले...

Robert Cook said...
"Making a class issue where there isn't one. If one doesn't seek medical attention what is there to be done?"

Perhaps they don't seek medical attention because they can't afford to."

Then why are we wasting so much money on Medicaid and Obamacare subsidies? If it isn't working, abolish it and let taxpayers keep more of their own money.

Jason म्हणाले...

Hmmm. I just remembered... some years ago, my wife's old employer (Toys R Us) had a discount medical plan for employees that made the deductible for routine stuff much lower. It provided more limited benefits for catastrophic events, but these people couldn't afford a standard 80/20 co-insurance for anything major, anyway.

The Toys R Us plan worked more like a discount plan than traditional insurance, but it was something their employees needed and could afford, even part time and would make the difference between a $10.00/hr employee being able to get insulin when she needed it or trying to ration it and go without. (no, these weren't kids. Lots of these people were in their 50s and 60s but had lost their jobs in 2008-2009.)

However, IMMEDIATELY after Obama signed the ACA, two things happened:

1.) The discount plan these folks could afford on a part-time income was scrapped (the ACA actually made it illegal).

2.) Every single one of the hourly full-timers was slashed to part-time, and had their hours strictly capped at 27 per week. All of them. The only people in the store with health benefits of ANY kind were the store manager and 1 or 2 assistant store managers. That was it. Work over 27 hours in a week you got written up. Do it again and you were fired.

Meanwhile, premiums and deductibles on the ACA plans were soaring, and these folks couldn't afford an individual plan even with the subsidies, because they could barely get enough paid hours at work to make their basic rent and food expenses.

Most of them voted for Obama, though. Tried to warn them.

अनामित म्हणाले...

Matt: The amount of things people can blame race on is truly amazing. Would those black and brown people still be whole if they'd gone to doctors in Africa or Latin/Central America?

Probably yes, because they wouldn't have developed Type 2 diabetes in the first place, in a poor country where eating too much and being sedentary were not options.

Yancey Ward म्हणाले...

I read the entire story- it doesn't even sound like a story of "inadequate care", at least not in the pejorative way that phrase is used in the story. It sounds like a difference in seeking help and following treatment guidelines. You are ultimately responsible for yourself.

CJinPA म्हणाले...

The circumstances that give rise to amputations are complex and often intertwined...

"...but it's racism."

rcocean म्हणाले...

Doctors refuse to work with and monitor patients to lose weight, eat a better diet, address the diabetes because they get $30,000-50,000 to amputate and a pittance otherwise. It's all about the benjamins, doncha know.

Your Doctor doesn't have to "work with" you to lose weight. Presumably, as an adult you can do it on your own. Eat less. Exercise more. As Reagan said: "There are simple solutions. There just aren't any easy ones".

Kelly म्हणाले...

My husband is white. He had a beer gut from hell. He’d gone to the VA for regular bloodwork and they found his vitamin D levels were extremely low. Told him nothing else. Around that time he got a Fitbit and began walking 20,000 steps a day, cut out booze and snacks. When he went back to the va for another checkup they raved over his improved numbers, all back to normal, even though he hadn’t lost much weight. Turns out they had put him on diabetic watch though they failed to tell him. He just happened to do all the right things they should have told him to do. Its a amazing what a little exercise and cutting out a few things can do for your health. His vitamin D levels were also back to normal turns out there’s a correlation between blood sugar and vitamin D. Who knew? Seems to me it would be worth cutting out some things and do some walking in order to save your eye sight or a limb.

rcocean म्हणाले...

I knew a diabetic who kept smoking even though she was told it was bad for her circulation. Eventually, she ended up having surgery, but avoided an amputation.

Jason म्हणाले...

I cried because I had no shoes.

Until I met a man who had no feet.

So I asked him, "Got any shoes you're not using?"

Robert Cook म्हणाले...

"I see Cookie quotes Fauxcahontas on her fake bankruptcy study."

You're making that up in your head.

Michael K म्हणाले...

However, doctors being inadequately compensated by Medicaid, are not always willing to take on new Medicaid patients.

When I first started in practice, I signed up for MediCal, the CA version of Medicaid. Finally my office staff implored me to quit. As a vascular surgeon the only MediCal patients I saw in the office were for varicose vein injection which took 6 months to get paid and MediCal paid $6 for the office visit. Our costs for the equipment, syringes and solutions, were more than that so we lost money on every case. I would still see MediCal patients referred by family docs but we didn't charge them anything. We did charge for trauma cases but rarely got paid. A favorite trick was to refuse the claim alleging it was past the date limit for claims. Then we tried registered mail but MediCal would not accept registered mail.

Of course California in those days had 25,000 employees to process MediCal claims.

Fernandinande म्हणाले...

Here's some stuff that's is Trump's fault, written in Sekret Kode:

As a white woman, I felt it was important to search specifically for a white doctor to treat my children.

The medical needs for White Americans differ from the general public and those looking for a physician who may be attune[d] to their needs may find WhiteDoctor.org a refreshing resource

Fernandinande म्हणाले...

I knew a diabetic who kept smoking even though she was told it was bad for her circulation.

I quit smoking cigarettes a few years ago and rapidly ballooned up into the "grotesquely obese" range: BMI 22 !

So these people should quit whining and start smoking.

Michael K म्हणाले...

Cookie, did you look up the "Medical Bankruptcy Project ?"

Himmelstein and Woolhandler have been pushing NHS style single payer for 30 years, I'm a little surprised they are still at it. That project was, of course part of Fauxcahontas work.

These figures are similar to findings from the CBP’s medical bankruptcy surveys in 2001 and 2007, which were authored by three researchers in the current study (Himmelstein, Thorne, and Woolhandler), and then-Harvard law professor Elizabeth Warren. As in those earlier studies, many debtors cited multiple contributors to their financial woes.

Come on, Cookie, I know more about this stuff than you do. You parrot the stuff put out by these Socialist Harvard (or now CUNY) faculty who have never ever worked in the private sector. Medical professors know about as much about medical care as full time economics professors know about business.

Fen म्हणाले...

Haven't we all learned by now that different races have different concepts of time?

That was funny.

But I'm wondering if the Tranny Activism is going to create a backlash that will swing all the way into racial identity politics.

Think about it - the myth that there are no differences between the sexes is being destroyed by male-to-female athletes who are dominating their female competitors to such an extent that it's just sick.

If people see that and start thinking " there really are distinct differences between the sexes", how long before they normalize the idea that there really are distinct differences between races?

Ironically, we will know the day that racism has been defeated - people will no longer be terrified of discussing the differences between races. It's only a forbidden topic because there is a fear racist people will use proof of differences to justify oppression.

Achilles म्हणाले...

Ann Althouse said...
The article is written carefully to avoid accusing nonwhites of just doing a worse job of taking care of themselves, but by doing that the differences look like they are basically economic. So it's another plea to care about economic disparities. You might not care that much if people have smaller houses or less money to spend on travel and entertainment, but these horrible amputations might make you see economic disparity in a different light.

These people are poor and and they are fat for the same reasons.

Getting the government more involved in their lives will exacerbate the reason they are poor and fat.

cubanbob म्हणाले...

Even people with some form of private or public insurance can lack adequate funds to cover expenses not paid by their insurance. The deductibles in my own insurance get higher each year. I can easily see people putting off seeking care because they can't even afford their deductibles or co-insurance, or because their insurer won't approve payment for treatment they need.

Gee Cook, did you ever contemplate this is a direct consequence of Obamacare?

Medical bills remain a big cause of bankruptcies in America.

Ever heard of Aflack? That is what it is for. Income replacement due to illness.

Trumpit म्हणाले...

"Hypothesis: control for IQ and a lot of the race/class effect goes away."

What the hell are you talking about?

~ Gordon Pasha म्हणाले...

This endocrinologist is here to tell you that the systematic admission of individuals with genetic insulin resistance will result in a diabetic population that will bankrupt the country.

The prevalence of diabetes (type 2 diabetes and type 1 diabetes) will increase by 54% to more than 54.9 million Americans between 2015 and 2030; annual deaths attributed to diabetes will climb by 38% to 385,800; and total annual medical and societal costs related to diabetes will increase 53% to more than $622 billion by 2030. Improvements in management reducing the annual incidence of morbidities and premature deaths related to diabetes over this time period will result in diabetes patients living longer, but requiring many years of comprehensive management of multiple chronic diseases, resulting in dramatically increased costs. Aggressive population health measures, including increased availability of diabetes prevention programs, could help millions of adults prevent or delay the progression to type 2 diabetes, thereby helping turn around these dire projections."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278808/

The real benefit of building wall will keep the country afloat financially.

Jason म्हणाले...

Well, yes, there's that, too. And despite some big advances in synthetic insulin development, the global manufacturing capacity is nowhere near keeping up with the demand -- which, of course, pushes up insulin prices. And you can't make that go away with free/discounted insulin programs for the needy. That just makes the cost burden that much greater on everyone else.

Achilles म्हणाले...

My wife is a home health Nurse. A solid percentage of her visits are to people who get pressure ulcers.

You get pressure ulcers because you never move.

There are many people who literally occupy the same piece of furniture 24/7 and they only move when my wife rolls them over to treat wounds on their back and their ass.

They are carted off to the emergency room every now and then.

effinayright म्हणाले...

TheDopeFromHope said...
Obama in August 2009: Doctors refuse to work with and monitor patients to lose weight, eat a better diet, address the diabetes because they get $30,000-50,000 to amputate and a pittance otherwise. It's all about the benjamins, doncha know.
*************

I hope you're being facetious here.

* Doctors who work with diabetics are not the same doctors who do amputations.

* Doctors who work with diabetics DO "work with and monitor patients to lose weight, eat a better diet, address the diabetes." I'm mildly diabetic, largely because my doctor works with me on all those things.

* Obama was dead wrong about the fees surgeons charge for amputations:

https://www.healthleadersmedia.com/strategy/obama-missteps-foot-amputation-pay-surgeons

"President Obama got his facts completely wrong," according to a statement from the ACS, whose 74,000 members make it the largest organization of surgeons in the world."In fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation," sais ACS, which is care that includes evaluation of the patient the day of the operation and follow-up care that is provided for 90 days after the operation."

Other than that, you're spot on!

Automatic_Wing म्हणाले...

At least with regard to Mexicans and Central Americans, there's a substantial genetic component to their increased risk of diabetes.

https://www.sciencemag.org/news/2015/06/maya-ancestry-may-help-explain-high-risk-diabetes-mexico

Amy म्हणाले...

@Kelly at 11:20am - great story and kudos to your husband. Walking can be an optimum form of exercise and no additional equipment is needed, and everyone has access to somewhere to walk. That is why the protesting about not having access to exercise is not credible to me.

Get out and use what you have available. Then build from there. Or is that too close to encouraging 'bootstrapping' which is verboten these days?

gilbar म्हणाले...

Trumpit said...
"Hypothesis: control for IQ and a lot of the race/class effect goes away."
What the hell are you talking about?


Isn't it Cool, when people voluntarily submit Proofs of other people's assertions?
Thanx Trumpit!

gilbar म्हणाले...

everyone has access to somewhere to walk
AND! a LOT of that walking access leads DIRECTLY to fishing spots!

Tyrone Slothrop म्हणाले...

I've been type 1 diabetic for 28 years. Still have both eyes and all my extremities, My A1c is 6.4. It can be done, if you give a shit.

WK म्हणाले...

If only there were some way to give these folks a leg up.

Michael K म्हणाले...

I've been type 1 diabetic for 28 years.

My younger son, too. He just turned 50. He's a firefighter.

Robert Cook म्हणाले...

"'Even people with some form of private or public insurance can lack adequate funds to cover expenses not paid by their insurance. The deductibles in my own insurance get higher each year. I can easily see people putting off seeking care because they can't even afford their deductibles or co-insurance, or because their insurer won't approve payment for treatment they need.'

"Gee Cook, did you ever contemplate this is a direct consequence of Obamacare?"


I don't know; they were increasing annually before the ACA existed, so I don't know if or how much ACA exacerbated the trend. I was not a proponent of ACA, as it is basically a giveaway to the insurance companies, providing them a captive new audience. On the other hand, there are people who have been able to get insurance due to ACA who could not get it previously, so, absent any better ideas, I think the ACA has been a net gain for the many Americans. However, that's like saying having polluted water to drink is an improvement over having no water to drink. I'd happily see ACA scrapped if a better means of providing affordable medical care to everyone were implemented.

chuck म्हणाले...

> This stuff is controllable, but it takes discipline.

I had an uncle who had diabetes for decades and made it into his 90's without complications. He was very disciplined about balancing food/exercise and kept track of his blood sugar by testing often. He was still a pretty spry guy last time I saw him. Note that he wasn't especially educated, but he knew how to keep to a program.

exhelodrvr1 म्हणाले...

Can't they just self-identify as healthy? That works for everything else!

अनामित म्हणाले...

I was diagnosed with Type 1 in 2017, when I was 67.
Managing this disease is complicated; it even involves some math (how many carbs in the food I'm planning to eat, then how much insulin do I take, based on a ratio per carb unit, which I have to determine myself and which can change day to day).And that's not even getting into determining which foods are proteins, fats, dairy, carbs and trying to balance them with sodium and cholesterol numbers.
I was overwhelmed when the diabetes educator was training me in the hospital. I'm pretty well educated, but my first night home from hospital, I accidentally gave myself the wrong insulin/wrong dosage, which could have been fatal.
It isn't 'prejudice' to think that poorly-educated and/or less intelligent people are going to be less successful in managing their diabetes (either type).

gspencer म्हणाले...

"The circumstances that give rise to amputations are complex and often intertwined"

But some things are definitely known medical researchers and medical practitioners. Trump and the GOP and their supporters are at fault, as well as those who believe in limiting government and letting personal responsibility be each person's guiding principle.

Fernandinande म्हणाले...

Charles somebody.

Also Gottfredson, although she is mostly ignored by the press, not being a white male worthy of being picked on.

Hypothesis: control for IQ and a lot of the race/class effect goes away.

"Perhaps the most stunning finding is that once one accounts for the AFQT score, the entire racial gap in mobility is eliminated for a broad portion of the distribution. At the very bottom and in the top half of the distribution a small gap remains, but it is not statistically significant."

Tyrone Slothrop म्हणाले...

Anonymous said...
I was diagnosed with Type 1 in 2017, when I was 67.


You MUST get a continuous glucose monitor. Medicare will cover it 100%. I have a Dexcom 6, and it helped my lower my A1c by a full point.

Michael K म्हणाले...

I had an uncle who had diabetes for decades and made it into his 90's without complications.

Charles Evans Hughes' daughter was one of the first children to receive insulin when it was discovered.

The daughter of the esteemed Charles Evans Hughes, Elizabeth was granted an early meeting with Frederick Banting, the discoverer of insulin.

But his prestige and power could not protect his children. In April of 1919, his daughter, Helen, contracted tuberculosis and died the following year. Also in April of 1919, his spry, curious 12-year-old daughter, Elizabeth, the one who frequently sported skinned knees from her explorations of Central Park and who was so enraptured by nature that she memorized the names of trees in alphabetic order, was diagnosed with diabetes. It was, in effect, a death sentence, as insulin had not been discovered. Elizabeth was taken to the country’s leading diabetic doctor, and though she had been losing weight and was only 75 pounds, the doctor did what he could to prolong her life: he starved her.


The starvation diet became popular before insulin as it had been discovered that diabetic children in Europe during the war (WWI) lived longer than those with normal diets.

By the summer of 1922, she had reached the outer limit of her life expectancy with diabetes – three years – and her end was coming near. Various illnesses (colds, an ulcerated tooth) had staggered her, she weighed less than 50 pounds, and her parents prepared to bury their second child in three years.

Then Elizabeth’s mother, Antoinette, read a news item about an experimental therapy being developed for diabetes, and on July 3, she wrote Frederick Banting at the University of Toronto to ask if he might help her daughter.


It's an interesting story,. She lived to age 73 and most of her family knew nothing of her diabetes.

In 1930, she married William T. Gossett, a young lawyer, but she didn’t tell him about her diabetes until after they were engaged. A two-volume biography of Charles Evans Hughes was published in 1951, three years after his death; Elizabeth and the rest of the family cooperated on one condition: the author not mention her diabetes. In fact, Elizabeth deleted any reference to her disease from her father’s papers. She also destroyed any photographs taken during her illness. Even after she became involved in various philanthropic activities, she never gave any money or support to any diabetic charity.

She had an amazing life.

In 1980, the medical historian Michael Bliss tracked down Elizabeth for his book on the discovery of insulin. She agreed to cooperate, on one condition: he could not use her real name, so he planned to call her “Katharine Lonsdale, the diabetic daughter of a prominent American political figure.”

The following year, after a trip to China, Elizabeth fell ill and was taken to the hospital with a blood sugar of 700. The doctors later discovered that she had suffered, fittingly enough, “silent heart attacks.” On April 25, 1981, after some 43,000 injections of insulin, she died at age 73.

Her obituaries included no reference to her diabetes. In life and in death, her secret was safe.

The Minnow Wrangler म्हणाले...

Michael K said, "Of course California in those days had 25,000 employees to process MediCal claims."

What? Only 25,000 employees to process claims! LOL. I sympathize with you and I also sympathize with Medicaid patients. My adult son is disabled and we are having a pretty hard time finding a dentist to accept him as a patient. But since they don't get paid a fair amount I don't really blame them for not wantinng more Medicaid patients.

Michael K म्हणाले...

I was not a proponent of ACA, as it is basically a giveaway to the insurance companies, providing them a captive new audience.

Once a month or two, I agree with Cookie. The insurance lobbyists and a bunch of 25 year old Congressional staffers wrote the law.

Hillary had made a mistake by excluding the insurance companies and Pelosi/Reid let them write the law to get them on board.

You have to understand that insurance companies HATE health insurance. It is a money loser. What they like is to be "Administrative Service Organizations." That's what they do with employer plans. They process claims,. the more the better, and the employer pays the bills. This is what the ACA was to be. They would process claims, the more the better, and the feds would pay the bills.

Two problems arose. Free stuff is very popular. It was free for the "poor." The middle class paid the tab with high premiums and high deductibles. They also proved to be incompetent. The web site was the first clue.

ConradBibby म्हणाले...

"Perhaps they don't seek medical attention because they can't afford to."

It says right in the article that Medicare and Medicaid are paying for most of these amputations, so clearly the affected people have coverage under those programs.

Now, if you want to argue that Medicare and Medicaid don't provide sufficient medical coverage to prevent tens of thousands of Californians from having to get their limbs amputated, fine. But then don't also tell me we need to have "Medicare for All," because I rather like my limbs and would prefer to keep them.

(BTW, I propose that "Medicare for All" be renamed "Medicaid for All," as I suspect this will prove more accurate in practice.)

stlcdr म्हणाले...

It's probably already been posited:

Being poor isn't the reason for not getting care; the reason they are poor is more than likely the same reason they don't get the care they require. Solving the 'poor' issue doesn't solve the 'care' issue.

Of course, this is a blanket statement, but I suspect solving the reason people are unable to establish an adequate income would solve a vast array of problems (and giving them money does not make them not poor).

Gospace म्हणाले...

Type 2 diabetes is first and foremost a lifestyle disease. My family is genetically prone to it. As in my two siblings, my father, and his father, all have (or had) it. I don't. I'm also the only one who hasn't become obese.

My A1C level is higher than I'd like- it's now monitored every doctor's office visit. I'm taking metformin- and was before the first time my A1C was checked. About 3 weeks ago I started a strict keto diet. So far, 10 pound weight loss. In 2 months I'll call the doctor and request a blood test be ordered up. I can't go into a lab and order a routine blood test because I live in NY and to save me from myself individual consumers are prohibited from ordering their own medical tests. Idiot DEMOCRATS are responsible for that idiotic law that prevents people from monitoring their own health. Driving up the cost of health care as we make unnecessary office visits to get tests ordered and see their results.

In this day and age, there's no excuse for anyone to get Type 2 diabetes. The cause is known- poor diet, overeating. The cure is simple- eat right, lose weight. You have to be serious about taking care of your health. My siblings weren't. One's a trained nurse.

There are a lot of lifestyle diseases that drive up healthcare spending. Alcoholism and drug addiction. Why my brother-in-law had a leg amputated. COPD caused by a lifetime of smoking. I see many people my age with oxygen tanks to help them breathe. Who unhook themselves every so often to grab a smoke. There's no one alive today in the United States who is not aware that tobacco in any form is BAD for the human body, yet people not only continue to use it, new people start every day.

Obesity is a huge driver of healthcare costs. And totally voluntary. I have a handful of female friends who are totally and completely not sympathetic to the obese and their health problems. All former fat women who got serious about their health, and figure if they could lose weight and keep it off, anyone can.

Why are the black and Latino communities more prone to diabetes? My unscientific observation is- when I look at the black and Latino communities, I see a lot more obese people. That's not the fault of medical professionals.

SomeoneHasToSayIt म्हणाले...

Type 2 is not a 'disease', as in 'something that you catch or get'.

It is a 'condition' that ensues when you consume too many carbohydrates, for too long.

It is reversed and eliminated with a high fat, moderate protein, low carb way of eating.

If the poor disproportionately have type 2, check to see if they disproportionately are obese from high card diets. You'll see the correlation, which does not necessarily mean causation, but could and probably does in this case.

No racism involved.

FIDO म्हणाले...

I agree: these people took very inadequate care of their own health.

Funny how at least one of those groups tends highly toward single parent homes, where sugar intake is unmonitored.

Rusty म्हणाले...


"Two problems arose. Free stuff is very popular. It was free for the "poor." The middle class paid the tab with high premiums and high deductibles. They also proved to be incompetent. The web site was the first clue."
can you name any government entity anywhere in the world that is efficient?

rcocean म्हणाले...

"Type 2 diabetes is first and foremost a lifestyle disease"

Yes, but it also has a genetic component. Some people are extremely fat and never lift a finger - result NO Type 2. Others are slightly overweight and do little exercise - result: Type 2.

Some people smoke chimney's with no effect, others get lung cancer at 49. Genetics plays a role.

Michael K म्हणाले...

it also has a genetic component

Oh yes. I was working on a consulting job in UK about 25 years ago. The other American doc (we were advising the NHS) was an HMO medical director from Colorado. We got talking about regional variation, a subject that Dartmouth did a lot of research on when I was there, and he told me that his HMO covered miners' unions. One town had a ton of diabetes and the complications,. The other mining town had little. He said he went down there to chew ass on the medical group because they did such a poor job with diabetes.

He got there and discovered all the miners in the town were Indians. Maybe PIma Indians.

Tina Trent म्हणाले...

"I've been type 1 diabetic for 28 years."

My brother and father too. Brother was under 1 when he developed it; father developed it in the same year, at 38.

Some think a still-unknown virus spike Type 1 manifestations in certain years. It is genetic and an entirely different disease from Type 2.

Watched them survive for years, under the most brutal prognoses, through willpower and discipline. But my brother's organs were affected due to the age he developed it, and back in the Sixties and early Seventies they didn't have the care protocols they developed a decade or two later.

So I know a lot about dialysis, and lobbied for dialysis patients (NOT the Kidney Foundation) in Georgia for some time. The people on dialysis who could manage to lobby were nearly all Type 1 or had some congenital kidney disease, not Type 2. They were sicker, but if they were alive they had already fought hard for it. They fought on horrifying issues like eliminating the exemption in the medical code that allowed virtually untrained technicians to administer dangerous drugs to dialysis patients but not to more equal pigs like us. Or having one nurse to treat 24 severely chronically ill patients being dialyzed. My brother screamed himself hoarse once strapped to a dialysis machine while the lady next to him died, and nobody was on the floor to help.

I believe these is an entire circle in hell for dialysis industry CEOs.

Around to early 2000s racial disparity in diabetes care outcomes became the big issue in the industry. Ungodly amounts of money was and is thrown at it now, most of it wasted on consultants and celebrities and worthless "public health education" interventions. Meanwhile the Type 1s are still orphan disease status. Nobody cares if they live or die because it affects all ethnicities pretty much equally, is genetic, not "social problem" oriented, and there aren't any social justice bennies to make off screeching about injustice.

Just like AIDS. We now spend 30K a month for any AIDS patient who wants to take pills that enable them to keep having risky sex while (possibly) limiting the chance of transmission. It is bankrupting the Medicaid prescription drug budget, and nobody dares say boo about it.

whitney म्हणाले...

Much of having a good result with a medical condition comes from compliance. Being able to take medication at the right time. It seems like it would be something simple. We all carry alarm clocks around with us now so if you need to take medication at the same time everyday set your alarms and always carry a supply with you. But many lower-income people don't and it's just because they're not that smart

Achilles म्हणाले...

Robert Cook said...


I don't know; they were increasing annually before the ACA existed, so I don't know if or how much ACA exacerbated the trend. I was not a proponent of ACA, as it is basically a giveaway to the insurance companies, providing them a captive new audience. On the other hand, there are people who have been able to get insurance due to ACA who could not get it previously, so, absent any better ideas, I think the ACA has been a net gain for the many Americans. However, that's like saying having polluted water to drink is an improvement over having no water to drink. I'd happily see ACA scrapped if a better means of providing affordable medical care to everyone were implemented.


The government was corrupt.

So we need medicare for all.

...

I am in the VA system. You do not want medicare for all. It is funny that anyone would think expanding the VA system to everyone would somehow make it better.


Seeing Red म्हणाले...

They'll always choose the simple pleasure of eating unhealthy, carb heavy food,

You bet I will. I’m not a rabbit.

MayBee म्हणाले...

Has anybody else here seen the guy in Chicago- he usually sits on Michigan Avenue on the Mag Mile or in the Loop- who obviously has diabetes and uses his gangrene legs as an attention-getter for panhandling. OMG. It's awful to see. He obviously could get help- there's no hospital that would turn him away and I've seen people in Northwestern scrubs chatting with him. Man.

MayBee म्हणाले...

My husband's aunt ended up with her foot almost amputated, in a hyperbaric chamber in the hospital for months. She never sought treatment for a wound in her foot that didn't heal, I think in part because she didn't want to be told she had diabetes and thus had to make a lifestyle change.

MayBee म्हणाले...

This is in LA County- where a lot of the middle class and poor people are Spanish speaking hispanic people, more than most of the country (or at least more than the midwest and eastern parts of the country). So it's hard to know how much that skews the information.

mockturtle म्हणाले...

Tina Trent @3:53: Spot on!!!

Narayanan म्हणाले...

Don't we need to know ethnic of doctors also?
To understand balance and disparity and desperation.

Narayanan म्हणाले...

..Still better off in the US than in Latin America or Subsaharan Africa..

Questionable!?

Don't total availed calories matter?

I'm Full of Soup म्हणाले...

Buddy of mine was diagnosed with Type 2 diabetes. It scared the crap out of him - he had just retired at age 64 and had never been had any health issues. He took his prescribed medicine, cut out 3 beers a day, went to his weekly orientation classes, ate chicken every day and lost over 40 pounds within 8 months. He now weighs what he weighed at 18. His doctor is almost ready to take him off his medicine.


I'm Full of Soup म्हणाले...

Oh and he is a white guy.

Michael K म्हणाले...

he usually sits on Michigan Avenue on the Mag Mile or in the Loop- who obviously has diabetes and uses his gangrene legs

Years ago, when I was still in training, we had a guy with lung cancer who would show up in the County Hospital admitting room when the weather was bad complaining of a cough and coughing up blood. They would get a chest X-ray on him and there was a lung cancer. He would get admitted and scheduled for a workup. It would take a few days while he enjoyed good food and a warm clean bed, Then they would have him scheduled for a bronchoscopy and other tests,. On the day they were scheduled, he would sign out AMA (against medical advice). A few months later, when the weather was wet or cold again, he would show up again. He thought he had a good deal but the lung cancer was bigger on xray each time,.

Ceciliahere म्हणाले...

Whenever I go food shopping I make a very unscientific survey in my local supermarket, which has all races shopping there. I notice at the checkout counter that Latinos speaking only Spanish who seemed to be new to USA had mostly fresh vegetables, fruit, etc. vs. pre-cooked foods and junk carb snacks.. The African-Americans mostly favor fresh chicken legs, Mac and cheese packages, and all sorts of junk carb foods. Also, the Black women pushing these carb carts, are overwhelmingly obese. My take away is that the next generation of Hispanics who become assimilated will also be eating a high carb diet with very few fresh veggies, fruit, etc. leading to obesity and then diabetes. It’s the American way.

Michael McNeil म्हणाले...

began walking 20,000 steps a day…

Ah! Ten (Roman) miles — for the legions anyway.

Michael McNeil म्हणाले...

Blacks, hispanics, and Pima indians all have significantly higher rates of diabetes than whites, in general (in the case of Pimas, off-the-chart rates). Likely due to genetic differences in response to carbohydrates in the diet (remember, Southwest US indians only got access to highly-refined grains and carbs ~150 years ago, vs thousands of years of a more spare diet).

Is the last sentence (particularly its parenthesized clause) above really true in the case of the Pima?

Certainly it is so for a great many Native Americans, but according to archaeologists the historic forebears of the modern Pima Indians were the Hohokam culture, whose civilization was centered on Snaketown — the former incarnation of (and in memory of which was named) “Phoenix,” Arizona.

This Hohokam people, perhaps migrants from central Mexico (it's been going on for a long time), introduced extensive agriculture, fueled by intensive irrigation into the area, beginning around 300 BC — growing corn (maize), beans, and squash for themselves. By 1000 AD, Hokokam civilization occupied some 26,000 square km (about 10,000 sq. mi.), a region around the size of the island of Sicily, or modern Israel + Palestine.

The foregoing implies an order of magnitude longer exposure to a high “grain and carb” diet for the Pima people than just the last century and a half since European contact.

(As for the Maya — also mentioned up-thread in a pointer to a scientific paper as being especially vulnerable to diabetes — they too for millennia have been practitioners of intensive agriculture involving grains. Thus the theory at top appears to be largely disproved, or at least in question.)

____
(See, e.g.: Stuart J. Fiedel, Prehistory of the Americas, Second Edition, 1992, Cambridge University Press, pp. 209-212 on the Hohokam)

Be म्हणाले...

Beans and Rice; plant fats. Isn't that a Vegan Diet? (shrug.)

glacial erratic म्हणाले...

No matter what the real cause, it will be whitey's fault.

MayBee म्हणाले...

Michael K said...

it is sad what some people do to themselves, isn't it?

Nichevo म्हणाले...

he usually sits on Michigan Avenue on the Mag Mile or in the Loop- who obviously has diabetes and uses his gangrene legs

Years ago, when I was still in training, we had a guy with lung cancer who would show up in the County Hospital admitting room when the weather was bad


When an enlightened Democrat government starts whacking these useless eaters, then you'll see that cost curve bend right the hell over.

Char Char Binks, Esq. म्हणाले...

Diabetes 2 is an illness of affluence, not poverty.

Bob Loblaw म्हणाले...

I have an ER doctor friend who comes home from every shift aggravated by what he sees. No matter what people come in for, there's a good chance they have undiagnosed diabetes. He's late leaving the hospital on a regular basis because he has to give the diabetes speech to the people who looked to need only a few stitches or whatnot.

Heather, RN in Canada म्हणाले...

I am an RN. I live in Canada, where there is (basic) universal health care. I work in dialysis, where probably 50% (if not more) of our patients are diabetic. Killing your kidneys is yet another complication of type 2 diabetes. We tell patients regularly "watch your diet, watch your fluid intake, you're going to kill your heart, and lose limbs" - those who listen live longer. Many don't(and die earlier) Sometimes it boils down to autonomy - a dialysis patient has so little control over their life that they just do want they want (people come in carrying food from McDonalds, and litres to drink!) - and they can't fathom that it will kill them faster, until everything starts to break down, and odf course by then it's too late....A side note about nurses and obesity - it is not uncommon to see overweight nurses (particularly older ones). Some of it is stupidity (see dialysis patients, above) - some of it is, I believe, related to shift work. I don't think it is yet fully understood how rotating shifts really messes up the body - not only in terms of food intake, but in terms of hormone regulation, and hormones regulate a lot of how the body uses food. I have fought weight issues my entire life (I am 60, was born a very low birth weight preemie) and shift work (and bad food advice, taught in nursing school!) have played their part. The best advice these days does involve low carb, intermittent fasting, etc -- it's hard to follow all of that when one works shift work.

Bob Loblaw म्हणाले...

My take away is that the next generation of Hispanics who become assimilated will also be eating a high carb diet with very few fresh veggies, fruit, etc. leading to obesity and then diabetes. It’s the American way.

A problem partially created by the government. Back when the program was called Food Stamps, sometimes they gave you actual surplus food (like "government cheese"). One thing they always had a surplus of is orange juice, which is basically desert in a glass from a nutrition standpoint even though people think it's health food.

Freeman Hunt म्हणाले...

Also, a metric of how well the local schools teach math. Is there another disease that is as merciless in its privileging of math skills? I doubt it. If a school blows it on teaching ratios or basic arithmetic, any of its students who become insulin-dependent diabetic (Type 1 or 2) are going to have a particularly hard time.

mockturtle म्हणाले...

Glacier erratic sez: No matter what the real cause, it will be whitey's fault.

Damned good and right it's our fault! And if we don't fess up we are racists!

Michael K म्हणाले...

Is the last sentence (particularly its parenthesized clause) above really true in the case of the Pima?

Much is probably genetic and why may be a question. It is probably wheat which was not exposed to the Indians.

Corn (maize) is deficient in some amino acids. I don't know about beans.

I recommend "The 10,000 Year Explosion" It goes into detail about infectious diseases, and has some about diet and diabetes.

Tyrone Slothrop म्हणाले...

I agree with some who have said part of the problem is a language barrier. I'm a Kaiser Permanente member. My nephrologist is Chinese. My endocrinologist is Laotian. My primary care is Vietnamese. They are all fine doctors and nice people, but it gets to be embarrassing to ask them three times to repeat their instructions because their accents are so bad. You don't want to get that stuff wrong.

James K म्हणाले...

“The daughter of the esteemed Charles Evans Hughes, Elizabeth was granted an early meeting with Frederick Banting, the discoverer of insulin.”

The NYT had a feature story a few years ago about the discovery of insulin. They were experimenting on diabetic dogs without success for years. Then one day they injected a lethargic diabetic dog with a new formulation, and the dog almost immediately peeled up and literally jumped off the examining table. That was it. Suddenly all these people who had been wasting away on diets of lettuce and hard boiled eggs had a new lease on life. Really am amazing story.

Michael McNeil म्हणाले...

Corn (maize) is deficient in some amino acids. I don't know about beans.

Because of corn's lysine deficiency, the connection between beans and maize (corn) in ancient native America is a deep one and quite complementary. As archaeologist Stuart J. Fiedel writes in Prehistory of the Americas (quoting…):

Maize alone could not have provided the ancient Mexicans with adequate nutrients; it lacks lysine, an amino acid that human beings require. However, if beans are eaten with maize, they supply the missing lysine, thus making maize a good source of protein. It is astonishing, at first glance, that since 5000 BC Mexicans have been eating maize and beans together. Obviously, they were not aware of the biochemical processes that make this practice beneficial, so how did the complementary use of maize and beans develop?

Perhaps farmers simply took advantage of the plants' habits; bean vines are often found in fields of maize, clinging to the stalks (Flannery 1973). However, beans were evidently cultivated in some parts of Mesoamerica (e.g., Tamaulipas) and in Peru many centuries prior to the cultivation of maize in those areas; so it would be a mistake to conclude that beans were domesticated and eaten just because they happened to grow in the vicinity of maize. Perhaps the custom spread because those groups that did combine maize and beans in their diet enjoyed better health and a lower mortality rate than those that did not, and so held a competitive advantage over them.

Even when complemented by beans, maize does not provide enough protein for lactating women or young children (Kaplan 1971). The early Mexican farmers obtained most of their high-quality protein from deer, rabbits, and other hunted game; but as the population grew and more land was put under cultivation, game must have become scarce. Unlike the farming peoples of the Old World, the farmers of Mesoamerica did not domesticate any large herbivores. There were few species native to the region that were potentially domesticable.

(/unQuote)
____
(Stuart J. Fiedel, Prehistory of the Americas, Second Edition, 1992, Cambridge University Press, pp. 180-181)

cf म्हणाले...

My experience, 2 outcomes:

Like Bagoh, dear neighbors in our SoCal 1980s middle class tract neighborhood, mestizo hispanic -- that is not aristocrat spaniard-blooded (like AOC) so much as "Indio"-blooded. Once they knew their abuelito was diabetic, it was probably too late, and his diet never changed and medicine didn't seem to help, lost one foot and eventually the other -- brutal. They weren't poor! they were a loving, traditional, multi-generational family but with a lot more flour tortillas than their ancestors, and perhaps less attention to their personal health as much as their kids health.

But at around the same time, also hispanic, the fabulous Food Editor at my paper, in his early 40s, and my friend. He brought me his dream that he was going to die, and I said "Jung says dreams never leave you to die, there is always more", and asked him if he had had a medical check-up lately. He had not so he did one. sure enough, the doc was alarmed, he was bordering the disease, pre-diabetic and it put the fear of god in him and that big, heavy-set fellow set to walking every damn day and eating with a new particularity.

within a year he had cleared himself free of the diagnosis, and remained so, hurray.

it does seem to take extraordinary exertion and discipline, and support. may this current discussion help contribute to better outcomes for all who might otherwise suffer.

mockturtle म्हणाले...

Beans and rice also make complete proteins when combined in a meal.

Nichevo म्हणाले...

One thing they always had a surplus of is orange juice, which is basically desert in a glass from a nutrition standpoint even though people think it's health food.

Wasn't it one of the real Old-Timers like Galen who said, the dose makes the poison? Orange juice is health food... When you drink it by the juice glass instead of by the tumbler.

Even Coca-Cola was popular in this country when people were in excellent health and at suitable body weight. Back then it was sold in the beautiful wasp-waist Raymond Loewy bottles. Correction. The 6 oz Raymond Loewy bottles. Now the bottle is 20 oz if it isn't 2L. The HFCS probably doesn't help either.

Michael K म्हणाले...

Wasn't it one of the real Old-Timers like Galen who said, the dose makes the poison?

It was Paracelsus who was a real character. It was he who discovered that Mercury would treat syphilis, which led to the old aphorism, "A night with Venus leads to a lifetime with Mercury."

He was eventually murdered by rivals, an outcome that Trump is trying to avoid.

exiledonmainstreet, green-eyed devil म्हणाले...

Gillette now features a morbidly obese woman in its' ads and fat people are told by the media and the educational system that they should feel proud of the body they have, even if that body is lugging around 50 or 100 extra pounds. (I was recently scolded by a woke - and thin- niece of mine for using the word "fat" to describe a fat person. I told her that I once was 40 pounds overweight. It's true that I hated the word "fat" applied to me. That made me determined to lose the weight, and I did.)

Yes, the factors mentioned by others in this thread (unwillingness to delay gratification, a sense of hopelessness) certainly contribute to the rise of Type II diabetes, but so does the Body Positivity movement, the stupid idea that all body shapes and sizes, including obese bodies, should be celebrated.

RigelDog म्हणाले...

"Old habits die hard" - it said, re the high simple-carb diet.}}}

The link between high carb and diabetes/overweight/cholesterol is STILL not commonly known or accepted. I know it, many here know it, there's plenty of scientific data behind the premise, but my doctors are often only passingly familiar with it and not big fans. It's as if the cure for cancer was just sitting there and hundreds of thousands/millions of people were jumping up down telling everyone, "Hey, I was diagnosed with cancer and not doing too well but when I drink a quart of tomato juice a day, eat eight ounces of crimini mushrooms, and avoid dairy, my cancer goes into remission" and no one pays much attention. Also, both my husband and I have between us told two gastroenterologists and one ear/nose/throat doctor that eating lower carb instantly quells acid reflux/heartburn. They've never heard of that cure and were only mildly interested. Meanwhile, if you read diabetes/low carb/keto type articles and message boards, you'll see the same great health changes noted over and over again by thousands of people, including the cessation of heartburn. Goes in reverse, too---I have been mostly off the healthy lower carb diet for a few months due to having minor surgery and the heartburn is right there again almost every day that I eat refined carbs. Started low carbing in earnest 5 days ago and heartburn is gone.

Gospace म्हणाले...

What RigelDog said is true. I hadn't heard of keto/low carb stopping heartburn. But noted that since starting a strict keto diet 3 weeks ago I haven't needed to take take a papaya pill which I was doing frequently.

Unknown म्हणाले...

> "A 2014 study by UCLA researchers found that people with diabetes in poorer neighborhoods in Los Angeles County were twice as likely to have a foot or leg amputated than those in wealthier areas. The difference was more than tenfold in some parts of the county."

correlation does not equal....

causation!

Did they give an IQ test in those comparative areas?

how about the Stanford Marshmallow Test?

"health insurance" is not a prevention. ACA completely failed at that.

Unknown म्हणाले...

In LA the "poor" areas will be Latino

https://edition.cnn.com/2013/10/15/health/latino-cardiovascular-disparities/index.html