Evaluating studies from a patient perspective

I just read a report about a study which said that major weight loss had no effect on cardiovascular disease in T2s, but of course, they should lose weight anyway. That kind of qualifier seems to be required in studies that show results contrary to received knowledge. Why couldn't they have just said weight loss had no effect on CV disease in T2s, and skipped the part about weight loss?

I think this involves assessing just what the relationship between doctor and patient should be. For example, a hypothetical patient with T2 might have metabolic syndrome adequately controlled by meds, no other comorbid conditions, and not be able to lose weight. So his CV risk factors are being controlled and there is no reason I can see to nag him to lose weight.

Another article I saw found no fault with a doctor publicly stating NJ governor Chris Christie was too morbidly obese to be president (not advocating any personal political stance here), because of his risk for CV disease. But, in fact, she knows nothing about his personal risk factors, and I think she had no business calling him out on it. Not to speak of the fact that other presidential candidates have had high-risk health problems, too.

Then there is the study in another thread about carb counting in T1s. Our overwhelming consensus here on TuD is that it does help, even though the study concluded that there is no difference from "usual care", whatever that means.

So what is perturbing to me is that these kind of studies and opinions devalue the insights of the person into their own health status, as if we were totally unaware of our health risks and what we want to prioritize. They talk about involving patients in their own care, but then dismiss our experiences and wisdom.

I think this is a major way in which medical care needs to evolve.

I am still sort of stymied by the "carb counting" thread because it doesn't make any sense to me. I was non-carb counting as recently as 2008 but, since I smoked that crackpipe, I can't imagine approaching food any other way, except maybe correlating the carbs with protein and maybe fat too but I would "convert" them to carbs which I think is still carb counting?

I think you are entirely correct in pointing out the shortcomings of these studies. I think that the problem with studies like this is that even if they discover something useful (which neither of these seem to have discovered, perhaps making them a complete waste of money that might've been better spent on test strips?), the institutionalization of medical care is such that any discovery will be years away from implementation. WE can talk about the studies online and if it's a tactical thing like "study reveals potato chips to be magical food that reduce A1C 20%!" we can try it out and see if it works but we won't get support, prescriptions for Ruffles or any potential recognition of the benefits until it trickles through the medical system likely years later. This is too long. There's a lot of hay to be made doing the stuff that people who get good results do (or have lifted from other people online...*cough cough*) but getting the "tips" turned in to results for other people is very difficult. Who is going to take advice from a crackpot named AcidRock? 8-)

I am a firm believer in the study's method's and methodology. I like to say if you put better data in, then you get better data out. If a researcher has a very good study design with accurate inclusion and exlusion criteria, then the findings have a much better chance to mean something. Also meta-anlaysis studies or studies of a statistical nature are limited based on the methodology of the study. The best I think you can draw from these studies is suggest a correlation or a causation. A statistical study cannot say that sugar causes T2DM (more on that in a second). Another good thing to review is where the research is published. If the article is published in an online journal that you have never heard of, then you can reasonably assume that it is not the best conducted research.

I read this opinion article online a few months ago in the NY times: http://opinionator.blogs.nytimes.com/2013/02/27/its-the-sugar-folks/. The actual research article is linked towards the top of the story (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0057873). The original study did a statistical review from 175 countries and came the the conclusion that the "increase in sugar availability (about one can of soda/day) was associated with increased diabetes prevalence by 1.1%". Now I have major questions about these findings. First off a statistical study has its own limitations and this is approaching or exceeding them IMO. Secondly, I doubt 175 countries count or label sugar in the same way. The authors must make some big guesses or opinions in order to complete this study. In other words I find little use in this study based on its design.

The first line of this Op/Ed, "Sugar is indeed toxic." !?!?!?!?!?!?!?!?! He cites the above study as the reason he can say sugar is toxic. It doesn't take a genious to see that this may be more than just an opinion based his citation. It does not get much better from there. As you may guess on his faulty logic he then goes on to say the FDA needs to enact laws to keep us safe! My pancreas nearly fell off when I read that!

For my own amusement or pain I sometimes read the comments sections. As you might expect there were people saying the link is clear and we need action! And organic chemists going whoa, slow down here we missed a few steps between 1 and 1,000! The best comment was from one of the authors of the research study,"sanjay k
As the principal author of this study, I wanted to clarify some of its details for scientifically (http://epianalysis.wordpress.com/2013/02/27/sugardiabetes/)." Even the PI is trying to seperate himself from this mess!

My point being you have to watch where you get your news from.

I believe you are referring to the recent publication of the Look Ahead trial in the JAMA. Hope Warshaw wrote about this over at DiabetesMine. You can read my post over there. Basically, this was an important study. A great deal of money was spent on this study in an attempt to reinforce the results of the Diabetes Prevention Program (DPP). The primary outcome of the study was to demonstrate evidence of CVD reductions with the DPP protocol. The DPP protocol uses a low fat calorie restricted diet with exercise to reduce weight. The key takeaway is:

The Look Ahead study failed to demonstrate the primary outcome and was stopped early!

OMG. Does anyone not have a clue? We have the government out betting everything that we can prevent diabetes with the DPP program. While the DPP program is marginally better than the "usual care," it really isn't very good. Did anyone not think to consider a low carb diet? I have to say, from a patient perspective, the science being funded is just weak. And then to have it spun in distorted ways, that is just wrong. As patients, perhaps we, even more than the "experts," understand that obesity is most likely just a symptom of diabetes. And we also can see some obvious things, like "Maybe low fat diet isn't very good for either controlling diabetes or reducing CVD!"

So many of us feel personally hurt and insulted to be told that we got diabetes because of personal failings. No doctor would ever call out a politician for having cancer or getting shot in the head, but they call them out for having diabetes and being obese. Perhaps people like Peter Attia get it, but sometimes I feel like only we as patients understand. And over the years I have developed an increasing mistrust in the whole medical system.

Natalie, you really punched one of my hot buttons with this sentence:

"They talk about involving patients in their own care, but then dismiss our experiences and wisdom."

That perfectly crystallizes one of my biggest chronic beefs with the health professions: they recite, like a sacred mantra, the premise that "the doctor can only advise; the patient is ultimately responsible for the decisions affecting their own health."

Yeah. Uh-huh. Sure. Just try actually doing that and watch what happens!

These people that do these kind of studies must have gotten there degree out of a Cracker Jack Box.

I was once asked to be on a study for Avastin, a drug to cure cancer. I did not join that study. Only recently was I made aware this study was supposed to have been for metastatic breast cancer patients, only. Mine was not metastatic.

The drug was approved, then approval was dropped because it wasn't working and it was too risky. I recently discovered it is being given to breast cancer patients along with chemo. Go figure. They said it killed a bunch of people who had colon cancer when given with chemo years back.

I am now on Avastin for wet macular degeneration. My blood glucose is going high. I asked the tech at the Retinal Specialist's office if Avastin could be the culprit and she said, no. Sorry. I've read three articles on the Internet that state it can, indeed, raise blood sugar. I'm had to raise my morning injection of Humulin Mix 70/30 by six units and watch my carb intake faithfully.

You have to be your own advocate. I think studies are mostly for money.