Wednesday, November 16, 2005

November's Rant: Media Misses the Point of World Diabetes Day

For those of you who weren't aware with it, Monday (November 14, 2005) was World Diabetes Day, which was organized by the International Diabetes Federation (more information can be found at: http://www.worlddiabetesday.org). The day was supported by the World Health Organization (WHO) and is considered a primary global awareness campaign for diabetes. World Diabetes Day (WDD) is, in the words of the organizers, "celebrated" (although I'm not sure it is an occasion that should necessarily be celebrated) each year on November 14, chosen because it was the birthday of Frederick Banting who, along with Charles Best, first conceived the idea which led to the discovery of insulin in 1922.

While I appreciate the legitimate efforts of reporters in the media who try to communicate the serious nature of diabetes, I also think we as people with diabetes need to be much more vigilant in our efforts to ensure that only ACCURATE diabetes information is communicated to the general public and that we correct factual errors, otherwise the whole point of National Diabetes Awareness Month is essentially missed.

For example, if you were to listen to the media, you might just believe that diabetes is caused exclusively by eating excessive junk food, and that no one gets diabetes from anything else. The media routinely fails to acknowledge the distinct etiological differences between Type 1 and Type 2, which leads to routine misunderstanding about what causes the condition, how it is treated and how it is managed. The solution, then, would be seen as a simple matter of having sufficient willpower to eat healthier and no one would have diabetes, therefore only those who don't have willpower get it. What's more, marginalizing the population with the less common form (Type 1) of the disease does not mean it doesn't exist or it is less important.

Consider the following column, which was published in this morning's Boston Globe:

The diabetes explosion
By Derrick Z. Jackson, Boston Globe Columnist
November 15, 2005

Being a couch potato may be as deadly as smoking a cigarette. It is National Diabetes Awareness Month and the latest statistics should turn awareness into alarm.

In the United States, diabetes is the sixth leading official cause of death, killing 73,000 people a year, and contributes to 224,000 deaths a year, according to Centers for Disease Control. But as obesity continues to explode in America, diabetes may very well pass smoking as a preventable killer. A new report by the Yale Schools of Public Health predicts that at current rates of increase, the number of diabetes-associated deaths will be 622,000 by the year 2025.

That would easily surpass the estimate 440,000 deaths a year attributed to smoking.

In developing countries, people worry about blindness from insect bites. The Yale report estimates that blindness from diabetes will nearly triple in the United States from 24,000 to 70,000 by 2025. Cases of kidney disease will nearly triple from 41,000 to 119,000. We often lament the amputees in civil wars abroad. Amputations caused by diabetes will triple in the United States from 82,000 to 239,000.

The medical costs and loss of work productivity associated with diabetes will also nearly triple, from its current $132 billion a year to $351 billion a year.

We are part of a new global outbreak. While avian bird flu and AIDS are certainly important for international summits, the World Health Organization and the International Diabetes Federation also warn that the number of people worldwide who have diabetes has exploded from 30 million in 1985 to 135 million in 1995 to 194 million in 2003. Unless things change, the number of people with diabetes will reach 333 million, 11 times the number of 1985.

With the proliferation of trash food and declines of physical activity around the world, no nation, regardless of wealth, is immune to this deadly outbreak. The number of people in China with diabetes may grown from 35 million today to between 80 million and 100 million in just the next four years. The number of people in Vietnam with the disease may double to 5 million by 2025. Diabetes is the fastest rising non-communicable disease in Kenya.

In India, lack of access to medical care has resulted in one out of every five diabetics receiving an amputation, compared to one in 13 in Germany. The number of diabetics in India is also expected to double, from 35 million today to 73 million by 2025. Pakistan and Japan are also considered hotspots for diabetes.

It appears that the United States has outsourced more than customer service call centers to places like India. News stories from India have public health officials railing against diets pushed by Western soda and snack companies and fast-food restaurants.

India once was a nation stereotyped as being a land of emaciation.

Today, 17% of children in the capital of New Delhi are overweight and obese as two-thirds of youth prefer hamburgers, pizza, and french fries to green vegetables, according to the Delhi Diabetes Research Centre. The research center also found that only 8% of children spend an hour a day in physical activity while 42% spend an hour watching television or playing computer games. Only 25% of children say they spend an hour doing anything outdoors. At least 81% of children go to a fast food joint at least once a week.

"Even the children who are not overweight achieve their model weight not because of being active or being healthy, but more because of dieting and eating poorly," said Dr. Ashok Jhingan, the chairman of the Delhi Diabetes Research Centre.

Jhingan echoed what many health experts in the United States have been arguing now for a decade. "The changing obesity epidemic is likely to make diabetes prevalence even higher. So we've recommended that schools and parents should encourage children to play games and limit junk food intake." Jhingan said, "The twin epidemic of obesity and diabetes already represent the biggest public health challenge of the 21st century."

In one city the center studied, Chennai, the prevalence of diabetes has more than tripled in just the last two decades, from 5.2% to an estimated 17.4%. The challenge is so global and so potentially devastating that the time is coming for communities and governments to view soda and trash food companies as dimly as Philip Morris. Just like in the United States, many families abroad see McDonald's, KFC, and Coke as treats, only to see them -- and television and video games -- become deadly addictions.

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While the author certainly intended to raise awareness on the seriousness of diabetes, he mislead the public by excluding critical information. Unfortunately, many of the sobering statistics cited in this column are due to the explosive growth in Type 2 diabetes, especially in countries like India and China, where the incidence of autoimmune Type 1 diabetes is virtually nil. Yet the author (and his editors) fail to even acknowledge that there are several different types of diabetes, and therefore only help to perpetuate misinformation that "healthier living" can somehow eradicate all forms of diabetes, including Type 1. Also, the underlying presumption is that all of the new medications that big pharmaceutical companies are spending billions on will benefit patients with Type 1, which is not the case at all. The fact is that there has been exactly one new treatment (an analog of the human hormone amylin branded as Symlin, or pramlintide) for Type 1 diabetes since insulin was discovered in 1922, and even that was only approved by the FDA less than 3 months ago.

I consider it my duty to address these issues as I see them, otherwise the problem will continue. Here is the letter I sent to the author:

Dear Mr. Jackson,

I appreciate the intent of your November 15, 2005 column "The Diabetes explosion," but considering the fact that November is National Diabetes Awareness month, you should be reprimanded for your failure to convey completely accurate information.

Most notably, you never even acknowledge the fact that that majority of the sobering statistics you cite are being driven by the explosive growth in Type 2 diabetes around the world. Unfortunately, your failure to acknowledge that simple fact gives readers the mistaken impression that all forms of diabetes can be somehow prevented with exercise and better health habits, which is completely false. Eliminating junk food will do nothing to prevent Type 1 diabetes, which is an autoimmune disease that has no connection to obesity. So far, no major study has been able to prevent its occurrence either, including the recently concluded NIH-sponsored Diabetes Prevention Trials (DPT-1 and DPT-2), both of which failed to prevent Type 1 diabetes from occurring using either injected or oral insulin administration.

Unfortunately, you blew it. Your failure to acknowledge such a critical piece of information (namely, the type of diabetes) makes a mockery of the whole point of National Diabetes Awareness month, as it misleads the public and misrepresents the facts. That does not help the cause of improving Diabetes Awareness.

Regards, Scott Strumello

The burden is on us to read articles such as these and taking it upon ourselves to correct the authors when they mis-state facts or exclude relevant information. If we want public opinion to support our efforts to fund cure-related research, we must be more vocal in representing ourselves by not permitting misrepresentation of the facts. No one is going to act on our behalf, so we must do it ourselves.

2 comments:

Johnboy said...

Scott, you are right. Since the incidence of T2 is so much higher and can be prevented or at least delayed in many cases through good habits, it hogs the coverage.

I agree that any good awareness-oriented article should at least have one paragraph that briefly covers the difference between the two types to help curb public misperceptions.

Thanks for being such a good and active advocate!

Scott said...

It is a great pleasure to advocate for all of us, but its also our collective responsibility! Cheers.