diabetes as a surgical disease.

[Veneficus]

Got this article in my email today.

http://www.medscape.com/viewarticle/767815

Thought I would share it.

"Hi. I'm Dr. Henry Black. I'm Clinical Professor of Internal Medicine at the New York University School of Medicine, a member of the Center for the Prevention of Cardiovascular Disease at that institution, and former President of the American Society of Hypertension. If I had said 10 years ago that diabetes was going to become a surgical disease, I think I would have been laughed off the stage; yet, increasing evidence shows that this may not be a completely far-out idea."

 

[Aidey]

The abbreviated version for those without a medscape account.

Reducing caloric intake makes fat people healthier. Since people can't/won't follow diet and exercise instructions the various types of surgery limiting gastric size are the best option to reduce the incidence of diabetes.

 

[Veneficus]

I was more amazed that people were starting to figure out that what constitutes a medical or surgical disease is becomming more grey.

People are finally starting to catch on

 

[NYMedic828]

I'm more amazed that we haven't began to make obesity less acceptable in society...

All we do is continue to entertain conditions we know to cause disease and then tell society it's not your fault you are diabetic, it's because your parents were! Meanwhile, your parents are overweight and unhealthy.

Its one thing when someone is truly misfortuned and CAN'T help themselves but I have no sympathy for people who simply won't, and what someone else to do it for them. I honestly don't feel people deserve the time and effort and massive costs behind receiving surgical interventions when the most simple fix to their condition rests solely in their hands.

Don't get me wrong, advances in medicine are always a great thing, but how they are implemented and why is another.

 

[Dwindlin]

Don't think the surgical option will (re)catch on honestly. . .

We have known for some time that bypass especially can fix most of the problems that come with obesity, and initially most insurance companies covered it, hoping to save themselves some cash in the long run. Well, they stopped because they generally do not work in the long term. I haven't seen anything to suggest that has changed.

Honestly these two studies he is going on about demonstrate nothing we didn't already know. I'm not sure why Dr. Black thinks any of this is news worthy. . .

 

[jwk]

It's a gross oversimplification of the problem. Type II diabetics MAY get better with weight loss, whether through surgery or diet and exercise. Those with Type I diabetes will not.

 

[MSDeltaFlt]

And I didn't read one single thing in that study mentioning "lifestyle changes". Decreasing caloric intake and increasing base metabolic rate will really improve health and lower body weight. They also mentioned "reoperations". That tells me the pts still wouldn't change their lifestyle. It all boils down to choice. And making it a surgical disease coverable under insurance simply makes no sense and blows my mind.

It's simple, people. Do what your parents told you when you were a kid: go outside and play.

 

[firetender]

Don't you recognize marketing when you see it?

 

[mycrofft]

Not if it's GOOD marketing.

When did insurance companies stop underwriting bariatric surgeries? Not only are bariatric surgeries for "weight loses" per se, but also to open a time windrow wherein a patient can undergo another necessary surgery.

Bariatric surgery regimen has a dark side, besides most studies of it being underwritten by interested parties. Postop, the surgeon is done with you. Your primary care doc usually is not really conversant with it, and refers you to ....whom? Why, a peer support group, usually led by a nutritionist or a nurse. Like using Alcoholics Anonymous for cancer.
Looking at studies done in Australia, where national health care covered lap bands for quite a while, people tend to put weight back on after a precipitous drop, but still wind up lower than they started.

Society at one hand socially condemns fat people, yet supports eating for fun, for for being sexy, etc, just as it does drinking alcohol and using tobacco.

Back to OP, hopefully diabetes can begin a bridge between the medicine versus surgery gap.

 

[NYMedic828]

It's a gross oversimplification of the problem. Type II diabetics MAY get better with weight loss, whether through surgery or diet and exercise. Those with Type I diabetes will not.

Hence why I stated, I don't mind rendering aid to those who are truly unfortunate.

But those who develop it because they eat 3000 calories at mcdonalds per meal and never set foot outside or in a gym, I have no feeling for.

 

[Veneficus]

And I didn't read one single thing in that study mentioning "lifestyle changes". Decreasing caloric intake and increasing base metabolic rate will really improve health and lower body weight. They also mentioned "reoperations". That tells me the pts still wouldn't change their lifestyle. It all boils down to choice. And making it a surgical disease coverable under insurance simply makes no sense and blows my mind.

It's simple, people. Do what your parents told you when you were a kid: go outside and play.

In the article it says that it is a substitute for lifestyle changes which people are not embracing.

I think the question is: Is the surgery cheaper than the long term consequences of doing nothing?

 

[Dwindlin]

In the article it says that it is a substitute for lifestyle changes which people are not embracing.

I think the question is: Is the surgery cheaper than the long term consequences of doing nothing?

Not sure about other places, but in the states the relapse rate after surgery is pretty high. For the most part it was a wash, hence why insurance companies stopped covering it.

 

[Veneficus]

Not sure about other places, but in the states the relapse rate after surgery is pretty high. For the most part it was a wash, hence why insurance companies stopped covering it.

I thought it was dependant on whether banding or bypass was used?

As I understand, and I could be wrong, the bypass worked better than the banding?

 

[DrankTheKoolaid]

And what about the untold stories of these banding and Ruh-n-y (sp) procedures. They act like there are no ill effects to these. I personally know of 2 locals that died within a year of having due to the complications associated with it. And while it may possibly decrease medical costs associated with NIDDM/IDDM what about the repeated ED visits and acute stays secondary to complications. If these people are so lacking in self discipline that they cant cure their own Hand to Mouth disease why is surgery going to make a difference. We all know that they simply Yo-Yo back to morbid obesity once they adapt to the procedure. Obviously there are success cases, but im sure there are as many if not more that go back to or near their baseline.

 

[Veneficus]

And what about the untold stories of these banding and Ruh-n-y (sp) procedures. They act like there are no ill effects to these. I personally know of 2 locals that died within a year of having due to the complications associated with it. And while it may possibly decrease medical costs associated with NIDDM/IDDM what about the repeated ED visits and acute stays secondary to complications. If these people are so lacking in self discipline that they cant cure their own Hand to Mouth disease why is surgery going to make a difference. We all know that they simply Yo-Yo back to morbid obesity once they adapt to the procedure. Obviously there are success cases, but im sure there are as many if not more that go back to or near their baseline.

How is that different from cardiac bypass or stenting?

 

[Dwindlin]

I thought it was dependant on whether banding or bypass was used?

As I understand, and I could be wrong, the bypass worked better than the banding?

Bypass does work better, but after the 5-year mark, people still tend to regain much of the weight.

Though I would find it interesting to see if there is a a difference in the failure rate now that people are paying for it themselves as opposed to insurance covering it. . .

 

[DrankTheKoolaid]

How is that different from cardiac bypass or stenting?

It's not.

This one of the few things about socialized medicine I agree with. With the limited healthcare dollars available, I feel they could be spent much more wisely if people had to qualify for these procedures. If you dont qualify pay cash, go to another country to have it done or perish. Coddling the weaker species simply weakens mankind in the longrun.

 

[Veneficus]

perspective...

I noticed 2 themes running through this thread and figured I would just call them out.

1. No surgery is safe. People were not meant to be surgically altered. If they were, they would have come with a zipper or two.

People function best when they have all of their original parts in working order.

Anyone advertizing surgery as "safe" is just marketing their service.

Surgery should be undertaken when the potential benefits outweigh the potential risks and outcomes.

That will be based largely on the particular circumstances of the individual patient.

Also, bariatric surgery of any kind, like every other type of surgery, needs to have follow on supportive care. This is most obvious in transplant patients, but applies to just about every other surgery I can think of, including dental.

Contrary to the popular idea in the whole western world, medicine, including surgery, is not like choosing something off of a menu at McDonalds. You don't select, pay, eat, and go on as if it never happened.

2. Judging who is worthy of medical care.

I will admit, I used to do this too. Then I had pathophysiology class in med school...

The long and short of it is: All of your diseases basically come from life choices. Deciding which ones are socially acceptable is not just inappropriate for medical providers, it actually harms people on many different levels.

It is easy to say things like drug users or obese people do not deserve medical aid.

Do women who get vaginosis? Pregnant? Sex is a choice.

Do people who engage in sports or dangerous recreational activities deserve medical care? They are making a choice that results in harm.

People who speed and don't obey traffic laws? (like Police, Fire, and EMS responders?) they made a conscious decision didn't they?

How about post streptococal glomuler nephritis? They chose not to go to the doctor when they had a sore throat didn't they?

I could go on, but I won't.

"Never judge. Always help."

 

[Veneficus]

Bypass does work better, but after the 5-year mark, people still tend to regain much of the weight.

Though I would find it interesting to see if there is a a difference in the failure rate now that people are paying for it themselves as opposed to insurance covering it. . .

I think the failure rate would be proportional to the post surgical care including lifestyle modifications.

I am not fool enough to think a bypass surgery is going to be a one shot solution to obesity to replace lifestyle modification.

Just like I don't think HTN cocktails and statins are going to solve cadiovascular diseases.

 

[DrankTheKoolaid]

I noticed 2 themes running through this thread and figured I would just call them out.

1. No surgery is safe. People were not meant to be surgically altered. If they were, they would have come with a zipper or two.

People function best when they have all of their original parts in working order.

Anyone advertizing surgery as "safe" is just marketing their service.

Surgery should be undertaken when the potential benefits outweigh the potential risks and outcomes.

That will be based largely on the particular circumstances of the individual patient.

Also, bariatric surgery of any kind, like every other type of surgery, needs to have follow on supportive care. This is most obvious in transplant patients, but applies to just about every other surgery I can think of, including dental.

Contrary to the popular idea in the whole western world, medicine, including surgery, is not like choosing something off of a menu at McDonalds. You don't select, pay, eat, and go on as if it never happened.

2. Judging who is worthy of medical care.

I will admit, I used to do this too. Then I had pathophysiology class in med school...

The long and short of it is: All of your diseases basically come from life choices. Deciding which ones are socially acceptable is not just inappropriate for medical providers, it actually harms people on many different levels.

It is easy to say things like drug users or obese people do not deserve medical aid.

Do women who get vaginosis? Pregnant? Sex is a choice.

Do people who engage in sports or dangerous recreational activities deserve medical care? They are making a choice that results in harm.

People who speed and don't obey traffic laws? (like Police, Fire, and EMS responders?) they made a conscious decision didn't they?

How about post streptococal glomuler nephritis? They chose not to go to the doctor when they had a sore throat didn't they?

I could go on, but I won't.

"Never judge. Always help."

Do people who engage in sports or dangerous recreational activities deserve medical care? They are making a choice that results in harm.

Why should joe tax payer have to pay for somebody who is a jobless 3rd generation welfare abuser sports injuries. When that energy could have been better spent on getting a job and being a productive member of society

Im not saying to judge as that is a personal thought. Im talking about using a point system like many. many other medical prodecures are scored on.

Transplant systems have this down and for a reason.