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An Evidence Based Skeptic Welcomes the Debate
Posted July 29, 2010 by Kevin A. Peterson, MD, MPH
As a family doctor I have seen enough change in prevailing health care recommendations to convince me that good evidence is the essential basis of good medicine. Call me an evidence-based primary care skeptic, and I won’t disagree. But good evidence takes a long time, and people suffering with diabetes shouldn’t have to wait for better therapy. While the prevalence of diabetes grows throughout the world, the treatment methods that we have historically relied upon continue to result in poor control and rates of complications that are far too high to ignore. Faced with alternatives that provide inadequate results, primary care providers make decisions every day that guide our patients down a path that we hope will prove to be more effective.
I joined the Endocrine Society’s Beta Cell team to help with decisions when I don’t have good evidence, and to make sure that I have access to a full and unbiased source of information about what should drive my advice, and what should not. The Beta Cell team includes expert insight from basic scientists, clinical trialists, endocrinologists, and primary care physicians to better look down the road to where diabetes treatment is going. One day we will have better evidence. But until we can confidently replace what we “think” with what we “know” the best alternative is to involve many experts and to explore the why and how of new therapies. I applaud the Endocrine Society for not providing another set of guidelines developed behind closed doors by appointed representatives steeped in conflicts of interest. Instead, as a primary care physician, I welcome this opportunity for open discussion and debate about new therapies as the best way to identify where a consensus exists and where it does not, to discover new ideas, and to explore differing perspectives.
Comments
BTW: you can call me a evidence skeptic for sure.
As a family doctor for 24 years, I am old enough to have observed this epidemic manifest. I wondered why we couldn't prevent it. I now understand the difference between the science vs. the business of medicine. I don't think of disease in isolation any more than I think of patient body parts working independently. There is no one cause of diabetes, nor solution. It represents imbalances in 3 core bodily functions--the HPA axis (stress system/autopilot), the immune system and cellular metabolism. All 3 are always on, always communicating with and affecting the others directly or via feedback loops. Here is an example: You have a food allergy that triggers an inflammatory process in the GI tract, triggers a systemic reaction of inflammatory cytokines, stresses the HPA axis, raises cortisol, which alters cellular response to insulin causing resistance. This causes impaired glucose utilization further alters cellular metabolism, and energy generation, loss of ATP, increases oxidation, kills off your mitochondria--> more loss of ATP and loss of cellular transmembrane potential, triggers calcium influx and cell death ( any cell). Any inflammatory process, any oxidative process, anything that interferes with normal cellular metabolism [abnormal methylation, sulfation, etc.] is sufficient to throw these things off. Going to disease land (diabetes, AD, HTN, cancer, heart disease, etc) have these underlying imbalances. Answers for diabetes will not come from the drug company underwritten studies that fill our medical journals--they are all mere band-aids. When we understand that it is necessary to return to the use of basic science and understand normal physiology and biochemistry and how the body parts interconnect [vs. our current reductionist ideology that has given us a great acute care system, but is an abysmal failure for all chronic disease] we will be able to help our patients. Diabetes is just one disease we are failing miserably at treating.
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