I don’t believe in: Santa, the Easter Bunny, that Pepsi tastes better than Coke, and that social media improves life, #getareallife. But I do believe that overdiagnosis and overtreatment are destroying billions of people’s lives. Antidepressants have marginal benefits and are grossly overprescribed; happiness is not in the gift of medication or medicine. Likewise, chronic pain is complex and often psychologically based, and the use of opioids and gabapentinoids does not work; it creates dependence and steals lives.
The ‘science’ behind common treatments for risk factors like osteoporosis, hypertension, and cholesterol is grossly flawed. Less medicine is better medicine. I get tired of saying the same thing, tired of the condescension, for, of course, I am ‘just a GP’ with no right to criticise the expert medical community. Oh well, here I go again.
Five years ago in the BMJ 1 I suggested that type 2 diabetes could be cured. This was based on a small study showing that weight reduction reversed diabetic biochemical profiles. This message was counter to the endocrinology dogma that ‘once a diabetic, always a diabetic’. Diabetologists rounded on me in the primary school playground that is Twitter. But a recent larger follow-up study irrefutably concludes that diabetes can indeed be cured (or put into remission if you prefer),2 and another that weight loss is achievable in primary care.3
Indeed, the relationship with weight and diabetic biochemical parameters is linear. The message is simple — lose weight and diabetes can be cured in the vast majority of patients with type 2 diabetes.
But diabetic care is now a multibillion-dollar business with a whole range of new agents coming to market, sporting names with too many consonants taken from the last third section of the alphabet. At meetings everyone nods knowingly about newly discovered improbable glucose pathways but you know they are all just faking it. Drugs are prescribed in ever-increasingly sickly polypharmacy cocktails, following incomprehensible flowcharts and inevitably leading to the addition of a new-style insulin. It makes no sense, to no one.
The costs of these diabetic medications have nearly doubled in a decade,4 now coming in at a staggering billion pounds a year. Sweet, sweet profits for Big Pharma and their paid diabetologist drug enforcers. And the research evidence of benefits makes little scientific sense either.5 The current confused narrative in diabetes is just plain wrong. There is a deafening silence from the specialist community about weight reduction and diabetic cure. Surely this is the most important breakthrough in diabetic care ever?
What of the opportunity cost? A billion pounds would provide every practice in the UK with four full-time professionals committed to weight loss. Think of the other cost savings from preventing the complications of diabetes that (in 2012 figures) run to 14 billion a year6 (similar to the total cost of primary care).
Our care is passive and defeatist: ‘just take your drugs’. It’s time for a new narrative and new approaches to care: ‘we can cure your diabetes, now let’s get on with it’.
Current diabetic treatment is truly terrible medicine.
- © British Journal of General Practice 2018