Terrible First Page Article in the Sunday NY Times

Todays Sunday Times has a first page article on the exploding cost of treating chronic diseases focusing on T1 and T2 diabetes. It is full of serious errors -

1. Type 2 can usually be managed through diet and exercise.
2. The new push to use insulin for T2s is not an appropriate shift in treatment to the best choice available for many patients.
3. Analog insulins are just a little bit better than NPH and R.
4. Pumps are probably over prescribed and not appropriate for young children.
5. There is something called 'hard to control" diabetes for which the best possible care is appropriate but most people with diabetes should be able to do fine with tools from the early 80s.

And there is more.

I'm in the middle of a final tax season push and can't do more than post this but someone and I hope a lot of people should to set the Times straight. The errors are set in a piece about the rising costs of treating chronic illness. There is a serious issue here. Does the society as a whole or the person with the condition bare the cost of expensive disease. It's a political and moral discussion which should be based on facts rather than fact like statements,

Maurie

I look at those 5 points and feel that they are all broadly correct.

#3, I was on N and R for several decades, and eventually found a MDI routine with R+N combination that worked well for me. Pre-MDI, they did not work so well. I've been doing analog insulins for 7 or 8 years now, and I see they have some advantages, but it's not really a breathtaking advantage.

In particular, #5, the early 80's were such a huge turning point in terms of diabetes treatment. Analog insulins and pumps and CGM's are further evolution, and they're important further evolutions, BUT... the big turning point was widely available home bg testing. I lived as a T1 in both the "before" and the "after" era. It was like stone knives and bearskins before home bg testing. Home bg testing was the most hugely signifigant improvement since the invention of insulin. Everything else since, not such a big deal.

Maurie - Can you add a link in your post to this story in the NY Times? The Times only allows free access for a few articles per month but allows unlimited access if a link is followed from another site.

I will try to read this story now!

Here's the link: http://www.nytimes.com/2014/04/06/health/even-small-medical-advances-can-mean-big-jumps-in-bills.html?hp&_r=0

Thanks for the perspective. I didn't live under any regime other than MDI with analogs before I started pumping so I'll let other old timers comment on them.

I don't think the points about T2 are correct. It is a progressive disease and diet and exercise isn't going to be a lifetime solution for most T2s. And if drugs are required an insulin regimen may well be the simplest and best for the patient.

Terry - I'm sorry but I'm helpless posting links with this software. I read the article the old fashioned way. Do you mind posting the link in a prominent place?

Thanks,

Maurie

The later edition of the Times made some corrections.

I agree I just read it and wow, talk about uninformed. i am really upset at the NYT and how sloppy that reporter wrote that article. It is embarrassing. stereotypes built on stereotypes. For instance lets discuss Nephrology, how many diabetics are not on dialysis today because their kidneys work? How about amputation? How many limbs saved because of tighter control. Shame on that woman. It is most upsetting and I dont get upset much anymore.

I saw they made a correction about Glucaglon. Were there others? I just read the online edition and it was still upsetting. Its not that difficult to get it right if you put your own biases away for a few minutes. She sat out to write an article and contrived facts and assumptions to make it work. Well, those facts are easy enough to find and the distortions are difficult ot erase once they are in print an article like this. Idgits.

This is the danger of someone who does not understand an illness writing about it. I even noticed that there was already a correction on the article, where the writer previously stated that glucagon was "an injection of concentrated sugar water." Even a quick look-up in Wikipedia could have corrected that assumption.

As a type 2, it frustrates me when people make assumptions that all type 2 diabetics can control their diabetes with diet and exercise, or that insulin is not an appropriate treatment for type 2 diabetics. I eat pretty healthily - better on average than my 110-pound, non-diabetic wife who eats cakes, cupcakes, donuts, and sweets on a regular basis. Yet even after trying very hard over the years to achieve and maintain proper BG levels, the insulin pump was a godsend for me.

Id id write the reporter directly and hope to get a response. if you look her up you can go to the NYT web site and email her directly. Please be respectful but point out her inaccuracies. i had to address some RA issues as well so I I am sure i did not get all the diabetic issues in one note. Especially type 2 issues. I am sorry I am just not that well versed.

I also asked he to visit TUD as a place that is operating without charge that helps diabetics and family members understand and treat the disease. Turns out she is a doctor, graduate of Harvard. i bet she never practiced Endo or Rhum and only has her two week rotation through each chronic disease she went after.

Surely the NYT can do better. i also made the point about looking at the entire issue. my mom was on dialysis for over 10 years, blind, feet like melons over 90 broken bones in each foot upon her death after 26 years with type 1. Yeah there may be a price to safer better drugs, but there may also be one to to throwing back the clock. Idgit reporter.

I'm so tired of articles like this that are not wrote by people who don't understand how the disease works. I have to find out how to send in my thoughts about this maybe to set them straight.

As an important data point from an old-timer, getting to the "meat" of that ny times article... when I was diagnosed a bottle of insulin was $4.00 at the pharmacy. By the time I was in college and paying for insulin out of pocket, a bottle of insulin was $7.00.

Today I take humalog and lantus and according to the mail order pharmacy paperwork it is over $150 a vial. That may just be "funny money" that hides the insurance company discount price, or it may be the real price (I see from past threads that those paying out of pocket are often paying that much), but that's just a hugely heinous price increase. I sometimes feel that I ought to go back to N and R because I was doing pretty well on those and I don't see why I should suck so many thousands of dollars from my employer's insurance company.

I'm going to respond, taking the risk that I will be flamed. I believe this article was well written and the point of it is timely and well made. Her premise is(to paraphrase)"Medical costs for chronic disease treatment in the US are spiraling out of control".
Recently my LADA progressed to the point where I needed to go on a full MDI regimen after 3 years of a Lantus/Metformin routine. If I didn't have insurance, I honestly could not afford the cost of my analog insulin plus testing supplies. I don't really have a choice to use anything BUT an analog(Humalog/Novalog)either.
She pretty much nailed it, showing the costs that an Insulin dependent diabetic bear. I am glad to see a non-diabetic take up the torch of medical costs, I only wish our legislators would listen to her.

Honestly, we can pick apart the article based on our views about how T1 and T2 are characterized, but I hope we don't lose sight of the point of the article.

Cost of diabetes care is spiraling out of control.

I think she did a good job, generally, about discussing why those costs are spiraling out of control from a market perspective. If I look at the cost of my care over the last 30 years since I was diagnosed, I've gone from being able to pretty much pay out of pocked for most of my supplies to being completely dependent on insurance for my supplies. I still end up paying more for out of pocked, now, based on my deductible and 20% share of DME.

I don't "need" a pump. I don't "need" analog insulins. Heck, I didn't really "need" flex pens when I was still on MDI. Trying to quantify how much the apex of technological advances in diabetic care (pump) has improved my control over the R and NPH + syringe I used 30 years ago is a difficult thing to do. My best guess tells me maybe 10 - 15% "better" Blood Glucose numbers. That's a difficult number to square with the fact that it would cost me near $1500 more a month out of pocket.

What a pump has done is bought me a much better "quality of life with diabetes", read, "a lifestyle as close to my lifestyle before diabetes without sacrificing complete loss of BG control". Admittedly, even that's difficult to square when you have people like Dr. Bernstein and his proponents basically stating that technology in diabetes care does not have to equate to better BG control and lifestyle choice does not mean sacrificing quality of life.

So, I know the general public has a lot to learn when it comes to completely understanding diabetes and what it's like to be diabetic. Heck, we argue about what that means, exactly, enough in these forums. But let's not drag the author too far over the coals without acknowledging that the article does offer much revelation into how completely screwed up it is to be a diabetic financially speaking.

I read this article this morning linked by a member in the Animas group and actually thought it was pretty good, though I did notice some of the glitches Maurie mentioned. Aside from the spiraling costs to me it also addressed another sacred cow in our culture the attitude towards technology that we continually get the newest thing, with only limited evaluation if "newer" is in fact significantly "better". In addition to "newer and better" (and more expensive) we are encouraged to indulge in the other popular capitalist twins of "conspicuous consumption paired with planned obsolescence.I've been fortunate enough to be diagnosed in a time with all the modern conveniences, but FHS brings up a good point that many people did very well for decades with far less. I worked for non-profits all my life and let's just say didn't have the most consistent job history. I chanced to work for a rural county agency for the last five years before retirement, that to compensate for pay lower than similar jobs in urban areas, gave excellent benefits. Consequently I got insurance for life which now combined with Medicare gives me 100% coverage of most things. I was diagnosed a month before retirement and had no idea how much I'd need that insurance and how grateful I'd be.

What the article only hinted at that most of us (myself included) find it more comfortable to ignore is how far past "necessary" we in the developed countries have stretched our "must haves". We crave and even feel we are entitled to government subsidy for the latest in pump and cgm technology every 4 years, while thousands (hundreds of thousands?) of our diabetic sisters and brothers in developing countries suffer severe complications from lack of decent medical care, nutrition, testing supplies and even insulin.

Not to disappoint you but I'm not going to flame. Healthy people take up the cost of treating those who are sick all of the time because they don't want to pay for them. And who can blame them? The fact is that the incremental improvements in care have increased our life expectancies, allowed more of us to work productively and prevented many, many complications. As a CDE said to me when I was first diagnosed. "When I started working at the Joslin the waiting room was full of seeing eye dogs. Not now."

Tim may be right that meters and MDI are the real cause of the improved situation. But there hasn't been any research to either prove or disprove that assertion.

My wife works with many relatively poor and elderly Type 2s. They are denied strips, training, appropriate medication and then are blamed for poor outcomes. Until articles like the one in the Times suggest meeting those unmet needs with the "savings" of more universally rationed care, permit me to be unimpressed by their seriousness.

Maurie

Maurie, the link I posted above works.

Because we are nothing but cash cows being milked by the drug companies. Look at all the technical developments. None invasive blood testers, shown working early 2000's, due for release in 2006. Company gets bought up and project shelved.

Look at the current artificial pancreas' under development. All of them pretty much double the number of consumables, thereby a lovely cash earner for the medical companies. It's not profitable to find a cure. The MINIMUM going rate for any D related item at the moment is 2000% profit margin (speaking to friends in some companies).

As for T2's and diet solutions. Very much so, the vast majority do very nicely on a diet solution (don't know one locally who doesn't manage it very easily on diet only). But as always there is always an exception, and while T2's on insulin are very rare. I've never seen any figures but wouldn't be surprised if it's not about the same or lass than the number as there are T1's out there, but you can see the financial benefits for encouraging a change to insulin on T2's for medical companies.

Pumps are insanely over priced. As pointed out above. But we live in a world where medical companies don't need to compete. They just need to change colours and fluffy features to "compete" with each other. Price competition and using market forces to get companies to actually compete are something which none of them wish to do, therefore it never happens. Is that an anti competitive market which should be regulated against? probably yes. Would it ever get regulation to force competition? with politicians in the back pockets of these companies? who are we kidding!

TIm what was your routine with N and R? How many shots and when?

Sorry Bertie, but you just have to say that you are a diabetic and you get automatically assumed you are T2. Why? Because that's all that is ever brought up in the press.

T1's don't make nearly enough noise to be heard! We might try, but it doesn't get through. T2's get the press due to the numbers and the end result of that is victimised kids, parents going do lally thinking they did wrong, and all the usual of getting associated you are a T2. We need to, and will continue to ram it into the politicians and press that we do exist!