Diabetes Self-Management Blog

Too many Americans live under medical control. We take multiple drugs to prevent bad things from happening to us. We are screened regularly for other potential diseases. Is all this medical intervention really good for us? Nortin Hadler, MD, says no.

Dr. Hadler is no radical or alternative medicine guru. He’s a rheumatologist and a professor at the Thurston Arthritis Research Center at the University of North Carolina at Chapel Hill. But in his book The Last Well Person Hadler makes a strong case that a large chunk, perhaps most, of American medicine does as much harm as good. The evidence supporting many therapies is weak and skewed by the influence of funders and sponsors. He implores us not to put blind faith in our doctors, but to keep control of our own lives and health.

Some examples: Hadler says coronary artery bypass surgery should almost never be done, because the risks outweigh the benefits. Prostate cancer screenings, he notes, come with risks of their own. He further contends that routine mammograms are unreliable, with many false negatives and false positives, since they cannot distinguish dangerous tumors from less-dangerous lumps that should be left alone. They lead to too many unnecessary biopsies and surgeries. Based on research, Hadler also criticizes the routine use of statin drugs for cholesterol, and screening colonoscopies for people who are not in their 50s or 60s.

We are all going to die — “The death rate is one per person,” says Hadler. The major controller of longevity and health is the difficulty of our lives. According to Hadler, socioeconomic status (SES) is the biggest determinant of longevity, job satisfaction is second, and social connection is third. Medical treatments don’t have much to say about it.

Hadler says the system is “medicalizing” our lives, turning everything from job performance to attention span to orgasms into medical problems. But they have no effective treatments for these problems. Why are we wasting so much time, energy, money, and comfort following doctors’ orders? We should focus instead on maximizing our quality of life.

How does Hadler’s insight relate to diabetes? For one thing, he thinks we should take a more relaxed approach to Type 2 in elders. “‘Normal’ blood sugar is age-dependent,” he writes. As glucose levels go up, risk of death increases only very gradually among older people. People can run higher-than-normal blood sugars and still be well. Hyperglycemia will cause damage over time, but older people have less time left for those complications to happen.

Hadler is critical of the United Kingdom Prospective Diabetes Study, which supposedly proved the value of tight control for people with Type 2. This study enrolled about 5,000 newly diagnosed Type 2s, age 48–60. After 12 years, the intensive therapy group showed less protein in their urine, and less leakage from blood vessels in the eyes. But they showed no decrease in eye or kidney damage, strokes or heart disease, peripheral neuropathy or all-cause mortality (although a follow-up ten years later found such a mortality difference.) So why, he asks “would anyone declare UKPDS supportive of intensive therapy?”

He says we should be even more cautious about the so-called “metabolic syndrome.” Over 40% of Americans aged 60—70 (and 25% of all adults) would qualify as having metabolic syndrome under the current definition — a large waist, bad cholesterol, high blood pressure, and high blood sugar. (Having three out of four qualifies you for the syndrome.) But strangely, American life spans have increased as the rate of metabolic syndrome has climbed. And the Americans who die the youngest, African-American men, have lower prevalence of metabolic syndrome than white men, white women, or African-American women. So how important could metabolic syndrome be?

Hadler believes that millions of people are being defined as “sick,” often based solely on lab numbers, so that drug companies and others can profit from “treating” us, whether or not the treatment actually makes our lives better or longer. He says we have a choice between being self-reliant individuals who think of ourselves as “well,” or becoming patients, depending on the medical system to tell us how we’re doing.

The downside of becoming a patient is loss of self-confidence, freedom, and possibly self-esteem. Most readers of this blog are already “patients” in the eyes of the system. Can you consider yourself a “well” person who just happens to have a health problem, one you can deal with? Or do you see yourself relying on doctors more and more? Hadler says being a well person (instead of a patient) requires courage to ask questions, do research, and sometimes say no to our doctors. Is that something you are prepared to do?

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I’ve got a new entry on my blog, Reasons to Live, about a cool guy who helps isolated older women and finds it rewarding. If you want some inspiration, check it out at http://davidsperorn.com/blog

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