Diabetes Day thoughts

November 14 was World Diabetes Day. Diabetes is overwhelming India. We have the largest number of diabetics in the world, and no one knows why.

Every year, on this day, doctors and pharma companies talk about diabetes in the newspapers, but sadly, their advice isn't really making a difference. You can make out it isn't because the numbers are increasing, and corporate hospitals are opening centres exclusively for diabetics. These centres are actually big hospitals, all set to cash in on the epidemic. Officially, India has 41 million diabetics, and the national prevalence is between 9 and 14 per cent.

As Diabetes Day approaches, marketers invariably find ways to give their products a diabetic spin. Take green tea. It's a good product, and is considered an anti-oxidant (said to put the brakes on ageing), but can it treat diabetes? Every season, we read articles about its benefits for both Type 1 and Type 2 diabetics. It is possible green tea has some peripheral benefits, but to promote it as a panacea for diabetics is surely an irresponsible bit of exaggeration? You will run into hundreds of such products, each claiming to magically help diabetics. Be warned that they all have an eye on the huge diabetic market, and may not help all that much in glucose control, even if they are good for non-diabetic consumers.

I do a bit of reading, mostly on the Net, to keep abreast of what is happening in diabetes research. Over the past year, I have stumbled across some startling reports. Doctors have found, for instance, that diabetes is a neurological problem, and that inflamed nerves in the pancreas could be the cause of diabetes. Just last week, an Australian research student found how insulin helps fat and muscle cells absorb sugar, and his peers say he may have found a missing piece of the diabetes jig-saw puzzle. A gastric procedure is ridding many Type 2 diabetics of their problem, but it isn't yet considered standard treatment. Many of these developments go against what our doctors routinely tell us, but you can't place all the blame at the doctors' doors because they have probably seen hundreds of promising discoveries just fizzling out.

Some researchers now believe doctors should aggressively start controlling blood sugars and prescribe insulin the moment a patient is diagnosed with diabetes. Is insulin better than the pills? A school of thought believes it is, but even doctors who subscribe to this school are prompted by patient reluctance to go with the pills.

The most surprising book I have read in recent years is Dr Bernstein's The Diabetes Solution, which postulates that the only way to deal with diabetes is to go low-carb and combine it with some exercise. This American doctor has his share of critics, most of whom believe that eating too much protein puts pressure on the kidneys. But he has a staunch following, and is a living example of what diabetics can achieve if they follow his methods. (He began his career as an engineer. When he realised his diabetes was killing him, he started experimenting on himself. He finally did an MBBS, and developed a dissident protocol for treating diabetes. He practises in New York).

Diabetes is a boon to the medical trade -- diabetics live for years and years after they are diagnosed, and spend heavily on doctors and medication -- but a nightmare to sufferers. Every now and then, we hear a cure is around the corner, but cynical diabetics believe the vested interests won't let it arrive.

How's business, doc?

Yesterday, a doctor complained to our reporter Sanchita Sen that the Indian Medical Association was making a fortune by endorsing Tropicana and Quaker oats, but wasn't willing to share the royalties with its branches.

Sanchita scented a story and perked up. When she filed her report, we asked ourselves two questions: Is it true that IMA Delhi is greedily keeping all the booty for itself? The second question bothered us more than the first: Is it ethical for India's premier doctors' organisation to suggest that one brand of fruit juice, or one brand of toothpaste, is better than another?

We did some calling up. A representative of the IMA in Delhi justified receiving money saying, "We have our own expenses to worry about." We called back IMA's Bangalore office-bearers with a simple question: Are you objecting to the ethics of endorsement or are you asking for a cut? It turned out they were more interested in the cash, although individual doctors did tell us the system of stamping products with "Recommended by the IMA" disturbed them.

Doctors are considered worthy of the greatest respect because they are believed to have the patient's interest at heart. But consider this: since the 1980s, pharma has transformed itself into the most profitable industry in the world, and has consistently outperformed traditionally more rewarding sectors like commercial banking. It has aggregated so much in profit that it funds thousands of university departments worldwide, and hires the brightest of talent emerging from medical and management schools. And these brilliant minds work towards formulating what a doctor reads, understands and believes.

Jacky Law, a journalist covering pharma, quit in 2004 to write a book on what she had seen of the trade. Her efforts yielded the book Big Pharma, which concludes that modern medicine has lost its way, and that "a relentless pursuit of profit is crowding out the public good".

Law reveals startling facts: Developing drugs is difficult, but once that is done, a company typically spends just $5 to manufacture a product that generates $100 in sales. Pharma spends up to 35 per cent on marketing, and yet delivers unbelievably high profits to its shareholders, sometimes to the extent of over 40 per cent a year.

You have probably seen Amitabh Bachchan endorsing Chyavanprash, and Wasim Akram and Naseeruddin Shah pushing blood glucose meters. Those are straightforward advertisements, but it emerges pharma giants have other insidious ways of raking in their millions (billions, actually).

Law reveals that the football legend Pele gave interviews encouraging men to discuss their sexual problems with their partners as part of a contract with Pfizer, manufacturers of Viagra, that wildly successful pill for erectile dysfunction. Shane Warne similarly received a secret packet to discuss in the media how he had quit smoking, and was furious when a fan took a picture of him clandestinely enjoying a smoke! And who were Warne's benefactors? Manufacturers of Nicorette "stop smoking gum"!

The dirty tricks department employed by pharma is more active than its peers in other industries. Take an example. Over the years, studies have emerged to scare huge new masses of people into taking statins for blood cholesterol levels (the cut-off point has come down from 280 mm per decilitre to 240 to below 100).

I frequently visit an online forum run by followers of a dissident diabetes doctor called Dr Richard Bernstein. He is one determined doctor who has taken on the establishment, and delivered what many believe is an effective, alternative approach to diabetes care. Of course he is unpopular among mainstream doctors. Need you ask?

I have personal reason to be sceptical about prescriptions. Ten years ago, I was told I had to take a pill every day, for as long as I lived, for my blood pressure. I took it for some years, and stopped for some reason I can't now recall. The last couple of times I visited a doctor, I was told my BP was normal!

Doctors are fallible, but they can't all be venal? I fervently wish modern-day healers who stumble on uncomfortable truths would speak out. Our lives are in their hands.