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May 16, 2006

What's So Bad About Diabetes Anyway?

Some priorities.  Keep in mind here that diabetes is probably the preeminent health threat of the near future, particularly from a cost perspective.  Researchers predict that one in three kids born in 2000 will contract Type 2 diabetes.  The disease currently costs $132 billion in productivity yearly and we spend $1.2 billion on research to cure and contain it:

In Worcester, Mass., scientists are boxing up their test tubes at a shuttered laboratory where just two years ago they isolated a chemical that triggers diabetes.

In Oklahoma City, health workers faced with soaring rates of Type 2 diabetes, the most common form of the disease, question whethaer they can afford to continue to offer classes where diabetics learn how to avoid foot amputations.

In Columbia, S.C., diabetes educators say they need more money to expand a program that uses the pulpit in black churches to preach the importance of a healthy diet and exercise.

Across the country, health care officials who rely on federal money to help stem the growing epidemic of Type 2 diabetes say they have become increasingly frustrated and alarmed.

Diabetes is the only major disease with a death rate that is still rising — up 22 percent since 1990 — and it has emerged as the leading cause of kidney failure, blindness and nontraumatic amputation.

But public health experts say federal spending on the disease has historically fallen short of what is needed. And now the government has cut diabetes funds in the budgets for this year and next, despite the explosive growth of a disease that now figures in the deaths of 225,000 Americans each year.

Words -- even snarky ones -- fail me.

May 16, 2006 | Permalink


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Tracked on May 20, 2006 8:29:09 PM


And, and, we subsidize the corn growers and producers of high-fructose corn syrup to artificially lower the cost of that sweetener compared to cane sugar. HFCS is terrible for our bodies, stimulates the appetite and is, IIRC, one of the culprits contributing to increased incidences of Type II Diabetes.

Posted by: Stephen | May 16, 2006 11:53:24 AM

A couple of weeks ago, the Times ran a very long article about how perverse the incentives are in our healthcare system. Doctors can make $30,000 amputating a limb, but nutritionists can't get reimbursed $175 for a 2-hour class teaching people how to eat so they can avoid limb amputations. All kinds of stupid crap like that that wouldn't exist in a single-payer environment that just makes you want to tear your hair out. I think diabetes, with its very expensive side effects, is the key disease that highlights why the U.S. system and way of life sucks and Europe's is so much better. Our sedentary lifestyle, diets extremely high in refined carbs, etc., and a public health system which gives people no help in the prevention of diabetes or management once people are afflicted.

If we could gear our public health system to preventing and treating diabetes, our healthcare system as a whole would save so much money, but nobody even notices these extremely expensive chronic illnesses flying under the radar. Like you said, from a cost perspective it is public enemy No. 1.

Posted by: spike | May 16, 2006 12:03:38 PM

See, the mistake you're making is thinking that the health care system exists to provide health care. Really, it exists to make being a doctor an important and well-paid job.

Those who get it confused just complain and complain. It's called cryabetes.

Posted by: Aaron Weber | May 16, 2006 12:15:07 PM

ezra, you write: "Keep in mind here that diabetes is probably the preeminent health threat of the near future, particularly from a cost perspective."

really? not alzheimer's disease, which is far and away the most financially exhausting disease on families and programs like medicaid (of which it certainly claims a disproportionate share). and people are getting in their early 60's these days, not just frai elders.

Diabetes is frightening yes, but Alzheimer's can bankrupt the country.

Posted by: chris | May 16, 2006 12:32:14 PM

I like your article. However, I believe your reasoning is suspect. What you have done is to first build a case that this is a horrible disease and then say "How dare this administration reduce the funding!" without looking at the bigger picture. A better question, but one that would not be as convenient for bashing Bush, would be "Has the overall spending on killer diseases gone up or down under Bush". I really don't know, but it's a much fairer question.

Posted by: Fred Jones | May 16, 2006 12:36:00 PM

Fred has a BushCo support talking point for every issue. If the answer to his question on overall spending on killer diseases revealed that it has gone down, he'd be saying that some other problem has received higher funding and that offsets the healthcare decrease. He would never question whether the $80 BILLION tax cut just passed was a good idea considering the needs of the people for health care.

Bush's priorities: always right, according to Fred. Don't worry about something that only affects one third of the nation's people.

Fred, Bush's priorites are the reason that by almost 2 to 1 the people feel that the nation is on the wrong track.

Why did Bush cut funding for about 10,000 border patrol agents out of THIS YEAR's Congressionally authorized spending and then yesterday call for spending some unknown but large amount on sending the National Guard to the border states - a move that nearly all observers will do little good since this a law enforcement problem - not a battle - and potentially lots of bad (considering the worn-out state of the Nat. Guard)? The answer is: bad priorities by BushCo.

Why are his priorities so FUBAR? He is uninterested, he is uninvolved, and he is shallow, self-absorbed, and disingenuous politician. The people now recognize that to be the case, and he's dead meat. Fred will be singing his praises all the way to historical scrapheap of failed and deeply flawed national leaders.

Ignoring diabetes is wrong, Fred. Wrong, wrong, wrong.

Posted by: JimPortlandOR | May 16, 2006 1:17:35 PM

Some timely quotes on BushCo tactics:

“Well, the National Guard is really, first of all, not trained for that mission,”

...added that that it would take a huge amount of National Guard troops, that they would need new training.

“I think it would be a horribly over-expensive and very difficult way to manage this problem,”

Is this some leftwing moonbeam speaking?

Read who said these things in December 2005

They were against it before they were for it (within six months). Sound familiar?

Posted by: JimPortlandOR | May 16, 2006 1:43:41 PM

"See, the mistake you're making is thinking that the health care system exists to provide health care. Really, it exists to make being a doctor an important and well-paid job."

And please tell me how that is different than any other profession. All professions are self-serving, I dont know why you are so shocked and outraged by that.

Posted by: joe blow | May 16, 2006 1:46:52 PM

"Doctors can make $30,000 amputating a limb, but nutritionists can't get reimbursed $175 for a 2-hour class teaching people how to eat so they can avoid limb amputations."

30k for limb amputation? Maybe $1500 at most.

Besides I think you miss the point. A high school dropout can tell you the basics of eating healthy. Why the hell would you want to spend $175 on something that is publicly available knowledge? I'd pay a high school student maybe $40 to do that.

For limb amputation its a different story. You need quite a bit of training, and if something goes wrong the person can die, there's a large amount of risk, etc.

Healthcare system doenst pay people based on KNOWLEDGE, it pays people based on skill. Thats why surgeons make more money than GPs. Knowledge flows freely over the internet, skills however, take practice and training time to refine.

Posted by: joe blow | May 16, 2006 1:50:31 PM

BTW, the answer to this problem is to cut the HIV/AIDS budget in half and devote those funds to diabetes, cardiovascular disease, stroke, etc

But of course the gay lobby wont stand for it.

HIV/AIDS is 100% preventable, and everybody and their brother knows how to prevent it.

Posted by: joe blow | May 16, 2006 1:52:00 PM

Of course, so, to some degree, are Type 2 diabetes, stroke, and cardiovascular disease.

And Fred, whether or not spending went up or down (or, more relevantly, exceeded the Clinton era's rate of growth), it shouldn't have been cut now. Not when we have enough money to give an $80 billion tax cut.

Posted by: Ezra | May 16, 2006 1:58:01 PM

Ahh, you've tripped me up, Joe. Maybe. It's possible that the surgeon himself will only make $1500, but the overall cost of the procedure would top $30,000. Also, I'm not saying a limb amputation shouldn't be properly reimbursed, I'm saying you should fund preventive measures which eliminate the need for the amputation.

You may think that everybody knows how to eat properly, but if that mattered, why would Type II Diabetes (they don't even call it adult onset anymore) be so prevalent? Clearly people DO need instruction on how to eat in a healthy way, and they need a professional who can bring it home and show the importance of eating well, too.

http://www.nytimes.com/2006/01/11/nyregion/nyregionspecial5/11diabetes.html?ex=1147924800&en=841ae0e584b73a91&ei=5070 if you're interested.

But hey, if you like paying for a Medicare system which gladly hands out $30K for an amputation but doesn't pay for preventive measures, keep your opinions.

Posted by: spike | May 16, 2006 2:07:46 PM

In re Joe Blow above: you misunderstand the need for diabetes education. You're right that pretty much everyone (including diabetics) already knows that a healthy diet and exercise are important. However, for many (if not most) people, knowledge isn't enough to change behavior. They need support and encouragement to do so, and that's what diabetes education is for. It's very similar to programs to help smokers stop smoking (I've never met a smoker who didn't know it was bad for them).
And to Chris: You're also right that Alzheimers is a huge problem. The difference is that there's very little we can do at the moment to prevent Alzheimers or minimize its effects. There is a LOT we can do about diabetes. That's what makes these funding cuts so idiotic: we save on education now, and then pay through the nose for amputations, dialysis and open-heart surgeries later. And Joe, you're right that an amputation doesn't cost $20,000, but cardiac bypass surgery does.

Posted by: Rebecca Allen, PhD, ARNP | May 16, 2006 2:22:49 PM

Awesome. We need to provide funding to help people understand more about what they already know will kill them. The article is great too. Spending has historically gone up and during that time we have seen an explosion in the growth of diabetes. Solution- more funding, no question.

Posted by: Alex | May 16, 2006 2:36:00 PM


Posted by: Fred Jones. | May 16, 2006 3:09:24 PM

Not when we have enough money to give an $80 billion tax cut.

Ezra, if your goal is to maximize revenue, tax cuts work and making them permanent is a good thing. However, if your goal is to punish the rich, then you may have a point.

April tax revenue 2nd-highest in history


WASHINGTON -- A flood of income tax payments pushed up government receipts to the second-highest level in history in April, giving the country a sizable surplus for the month.


Posted by: Fred Jones. | May 16, 2006 3:33:09 PM

I worked for four plus years with teenagers and young adults from poor areas in New England and New York and you would be surprised just how little these kids knew about a good diet. Assuming people know something is a recipe for disaster.

Posted by: jbou | May 16, 2006 6:36:34 PM

Dear Fred: inflation needs to be adjusted for when doing a rational analysis of 15 years ago with today - so second highest non-adjusted doesn't mean a whole lot.

Fred: Ezra, if your goal is to maximize revenue, tax cuts work and making them permanent is a good thing.

Yep, Fred, tax cuts work to improve things, but tax increases work better.

And increasing taxes means the country doesn't have to neglect important social services, like health care and education.

Posted by: JimPortlandOR | May 16, 2006 7:02:21 PM

I am a type 2 diabetic. There is nothing like lying on the gurney after ones' second heart attack from coronary artery disease associated with being a diabetic to concentrate the mind. So, I asked a lot of questions during the classes I took. It's true that the basic information with which these courses start is pretty simple, although it is indefensible to describe it as just "healthy eating" the way a high school dropout might understand the concept. It is also true, that there is a lot more to understanding how ones particular symptoms and disease might best be controlled. As with most education, the student generally gets out of it what the student puts in.

On the question of who benefits from the current structure of the health care system, our system allocates something between 30% and 50% of revenues to insurance companies, and about 25% to drug companies, with all other health care providers splitting somewhere between 25% and 45% of the money. At best, less than half of the money goes to people and institutions that actually see the patient and provide diagnostics and care. And that share is shrinking. Health care providers' costs are squeezed both by insurance companies and politicians. Control of insurance company and drug company earnings rests with Congress, the President, and some insurance commissioners at the various states. How are they doing so far? It is always surprising to me that someone can comment on health care costs without noticing that the place where most of the money goes is also the place where the foxes are in charge of the hen house.

The explanation for a failure to prioritize preventative treatment is also a result of ceding health care decision making to insurance companies. The most important part of the current structure is the struggle not to pay. Insurance companies spend enormous amounts trying to postpone and shift costs. A primary care physician needs to see 25 to 35 patients per day to support his/her practice. He/she has to average 14 to 19 minutes per patient. At that rate, physicians can't have many arguments about their patients' long term needs with insurance companies. Patients are on their own when it comes to health care system support for long term health. So, our system assumes that the vast majority of pre-diabetics will actually recognize their risk. Even putting aside doubts about that, patients still cannot behave like normal consumers. They rarely have the power to choose insurers and, for all practical purposes, they have limited power to choose their physicians. So they can't exercise the power consumers usually have to engage their health care providers in the preventative care they need. These are simple facts, but those who lead policy discussions about our health care system cannot seem to grasp them. I think that Mencken had something useful to say about that.

Posted by: Eric | May 16, 2006 8:44:22 PM

...inflation needs to be adjusted for when doing a rational analysis of 15 years ago with today - so second highest non-adjusted doesn't mean a whole lot.

Well, Jimmy, do you think that the difference would be 80 billion?? I would like to remind you that the tax cuts of the Reagan era produced a flood of revenue. Of course, the Congress went wild and we wound up with a net deficit. Tax cuts work every time they are tried. The reason is that there is an optimum taxation level. Too much and revenues decrease, too little and revenues decrease. We have rarely been undertaxed, so when taxes are cut it puts us closer to the optimum level and revenues go up.

I know this is in the aggregate and none of this discussion serves to further your class war against the wealthy, but if your goal is to maximize revenue, you must stay on top of the curve.

Posted by: Fred Jones | May 17, 2006 7:50:55 AM

Yep, Fred, tax cuts work to improve things, but tax increases work better.

As I stated above, there is an optimum amount of taxation. If your blanket statement was true, then we could just raise taxes to 98% and all of our problems would be solved.

And increasing taxes means the country doesn't have to neglect important social services, like health care and education.

See, the problem is you think your vision of cradle-to-grave big brother involvement is universal. It isn't. Who wants federal funding of education and the federal control that comes along with it as baggage? Doesn't that undermine the whole concept of independent school districts and local control?

The other issue you metioned is health care. So, you you really think there is solid consensus on big government health care as well??

What planet are you from?

Posted by: Fred Jones. | May 17, 2006 11:19:38 AM

There is no easy way to deal with this epidemic. Personal resposibility is probably the best way to cut down the new cases each year. I wish that when I was diagnosed prediabetic that I would have taken it more seriously. If I started exercising then like I do now that I am diabetic, I may have been able to slow down the progress of this disease.

Posted by: Jeff W | Aug 12, 2007 9:33:54 PM

Chris you are absolutely right.Alzheimer's prevention is important,because otherwise Alzheimer's can bankrupt the country.I think that is much more dangerous than Diabetes.

Posted by: steven davies | Dec 4, 2007 4:27:48 PM

The one-in-three-kids figure is totally alarming. I hope it doesn't get to be accurate. My son was born in 2004 and diabetes runs in both sides of the family =(

Posted by: diabetic neuropathy treatment | Aug 9, 2010 6:23:57 AM

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