New York Times April 5, 2014
(Even Small Medical Advances Can Mean Big Jumps in Bills)
Yesterday I got a little hot under the collar when I read a post originally made by Young at Heart concerning a New York Times (NYT) article dated April 5, 2014. First the discussion post is at this address
and the article in question can be viewed at the NYT page at:
As Young at Heart points out the author made several grievous mistakes concerning diabetic treatment. I won’t steel his post because he highlights them very well. There are two that upset me the most. First saying that pumps are not suitable for children really got under my skin. I believe that this is a misnomer, and what the author really meant to say is that pumps are not suitable for babies and toddlers and in that regard she (Dr. Elisabeth Rosenthal) might be correct. I have never had a baby or child with diabetes, so I do not know the age that doctors allow children to be placed on pumps.
I do know that many children use pumps. As a former school administrator I know for a fact that children as young as 6 have been prescribed pumps and that pumps are very common for 2nd graders and above. I think I got upset because Dr. Rosenthal’s generalization is a blanket statement and I expect doctors who write articles for the NYT to be correct. Especially Doctors educated at the Harvard school of Medicine. Heck I expect Doctors educated at the New Guinea school of medicine doctor to know better. I guess it is that bias I found unacceptable. Was she offering that children on pumps are not children or that pumps should not be given to children? Either way it was a grievous error.
Second, Dr. Rosenthal really cast a broad net around type 2 diabetics. I think that is likely what got Young at Heart stirred up a bit but I cannot speak for him. Young at Heart is more precise in his diabetic information than I am, so I learn from him especially about type 2 diabetes. The thing is the generalizations she uses about Type 2 Diabetics using exercise and diet to control the disease is again a misnomer and again it is painful. She forgets that many type 2’s use medications like metformin to assist in control of the disease and her story reinforces the very negative stereotypes associated with type 2. It is difficult enough to be type 2 without these stereotypes reinforced on the front page of the NYT.
Another negative stereotype was also advanced regarding Rheumatoid Arthritis (RA). Somehow that the biologic drugs used today give marginal benefit at extremely high costs. As the beneficiary of these drugs I can attest (my hands hurt today) as I type this, that there is no marginal benefit. These are very different drugs and for her to comment on them from an ill-informed position is grievous.
Now part of what Dr. Rosenthal wrote is correct. We should not let the good parts destroy the real message of the article. Namely that medical technology is designed with planned obsolesce and that sometimes small advances come with big expenses. Here is a personal example. I was using a Medtronic 721 pump. It was successful and really working out well. However my warranty expired and that qualified me for a new pump, the 721 was 4 years old and of course I could have continued just fine until the 721 gave up the ghost, but instead I got a new 722. The list cost was about $5,000, but the write down cost was $2,000 and of course I got a new 4 year warranty (4 years because the main purchaser was Medicare). However the advancements in pump design between the 721 and 722 were marginal at best.
Dr. Rosenthal also wrote about the very real issue of test strip cost. I agree with her assessment that makers are making a killing on selling test strips many of which cost more with marginal or no improvements in test strip quality. She states that the cost to manufacture a test strip is under $0.10 and at the high end each test strip can cost $1.50. That is at least a 15 time cost to sale ratio and yes that is obscene. I doubt any of us could deny that. In fact I would not even care about that, if the darn things were substantially more accurate. Even one standard deviation more accurate might be worth that kind of cost. The problem is she never examined or spoke of the accuracy issue and it seems to me she missed the boat on a ready made issue that fit her premise precisely. Nor did she speak of the alternative test strips in the market, namely the Walmart Brand (I have no idea how much it pains me to write something positive about Walmart) which costs a mere $0.18 per strip. Still approximately double the cost of manufacture and likely thought of as a loss leader for their store. Assuming these strips are as accurate (I have no reason to believe they are not) as other strips they are a bargain in the marketplace.
Once I cooled down a bit I wrote Dr. Rosenthal at the NYT and expressed my dissatisfaction with elements of her article. But I also told her the story of a place that operates at low cost and gives wonderful return on the medical dollar. Namely TUDiabetes.org, which is free to join, open 24 / 7 and is on the cutting edge of diabetic treatment. I invited her to visit us and write about this amazing web site. If you wish to respond to her you may do so at:
Send an E-Mail to Elisabeth Rosenthal at:
If you do please be respectful, but also invite her to visit TUDiabetes.org so she can have a second more enlightened story. If she does she can report on part of American Health Care that is working, namely diabetic social networking in general and TUDiabetes.org in particular. We have an amazing story to tell and that is one I would like to read.