The government deliberately floated the idea of cutting the medical research budget – mooted to be a $400 million cut, over what period was unclear – and in response to the howls of discontent and alarm from the affected community, it would now appear that the government, through the PM, has backed away from the idea.
Now it is difficult to calculate the optimal contribution of the government to medical research. Peter Costello was convinced that Australia underinvested in medical research and substantially increased the federal government’s expenditure. Not only is much medical research essentially a public good, but the activity is also global. There is a tendency to leave medical research to the big boys (especially the US) and for Australia simply to take up the innovations when they emerge.
The hysteria of the medical research profession in Australia has hit ridiculous heights with the suggestion that cutting the medical research budget by $400 million would led to foregone benefits of $129 billion – yes, $129 billion - and the loss of some 16oo medical research jobs. This figure was evidently arrived at by health economist. Maybe health economist are not actually economist because this figure is clearly LUDICROUS.
AUSTRALIA would stand to lose $129 billion and more than 1600 valuable researchers over the next eight years if the Gillard government cuts $400 million from medical research in next month’s budget, health economists say.
A group of experts led by Professor Nicholas Graves, of Queensland University of Technology, said the $129 billion loss would come from increased spending on health as a result of less research into how to keep medical costs down between now and 2020.
The economists said good health research reduced spending because it told policymakers what services to invest in for savings and why.(Really? And does this have to be Australian research?)
Examples included research into the efficacy of cancer screening programs (a highly contentious area) and ways of reducing hospital use. Without such research, Australia could expect to see healthcare spending grow by about 1 per cent on top of its annual average growth of 5.4 per cent each year.
”Since 1998, spending on Australian health services has grown each year by an average of 5.4 per cent. Expenditures of $107 billion in 2008-09 will rise to $226 billion in 2020 if this rate of growth remains steady,” the economists said.
”If spending increased 1 per cent more than 5.4 per cent due to poor health services decision making, then gross expenditures by 2020 will be $129 billion higher than $226 billion.
”There could also be worse health outcomes among the population.”
Moreover, the group, from seven different Australian universities, said that if the $400 million savings were found in job cuts, Australia could expect to lose 1644 experienced postdoctoral researchers on salaries of about $81,000 a year.
Given Australia’s economy was growing, they said any slight improvement in national debt as a result of the rumoured $400 million cuts to the National Health and Medical Research Council would not be worth it.
”The economic benefit associated with this is likely to be very small because the current net national debt is inconsequential when compared to the earning power of the Australian economy,” they said.
The figures came as Australia’s medical research community continued its fierce campaign against the predicted cuts, with dozens of notable scientists releasing a letter sent to Prime Minister Julia Gillard last Friday ahead of protests in Brisbane today.
Interestingly, Howard Florey is often mentioned in dispatches. Technically, he did not discover penicillin (that was Fleming) and all his research was undertaken in the UK (and some in the US). When he returned to Australia later in life, to be a grumpy head of the John Curtin School of Medical Research at the ANU, his research career was effectively over.
And the notion that medical research somehow gives hope to patients is surely a very poor rationale for public policy in this area (see Niki Savva in today’s Australian) - in part because the hope is often false (or too far into the future to be helpful) – and surely the providing of hope cannot be contained to Australian medical research.
As much as you can write things in bold and capitals, I don’t see why what they are saying is particularly unreasonable. Basically, if you read it, all they’re saying is that medical research will take 1% off the growth in medical expenses. That’s an entirely reasonable target. I would think that a program that stopped the increase in the proportion of the population that is fat could do that alone. Similarly, I would think that Australia’s research into mental health is already paying dividends, and these dividends could be quite large also. Both of these two things do have a big culturally specific component and thus free-loading won’t work, even if you have the people that can work out how to free-load (and that won’t necessarily be true — indeed probably won’t be — if you don’t fund medical research and keep decent people around. cf. the Department of Health).
To me the biggest problem is what gets cut — at present, the NH&MRC funds lots of things that apriori won’t help many people (e.g., research into disorders with small numbers of people, basic level research). However, thanks to the mentality of the baby-boomer squad that run it who like big machines and pretty pictures, these are less likely to get cut than the things that don’t require big machines or killing mice to do, i.e., all of preventative medicine.
conrad
19 Apr 11 at 5:54 pm
Conrad – one per cent, yes, looks modest but it is actually one percentage point. Health expenditure will grow 6.4 per cent per year rather than 5.4 per cent per year (estimated). I don’ think so.
Please note that I am not arguing the case for no Australian government spending on medical research and yes, there may be some cultural specific parts. But there are plenty that are not: research on pancreatic cancer, say, nothing culturally specific there.
The need for some research-types to assimilate the benefits of overseas research is an interesting idea but is there any evidence for this?
Judith Sloan
19 Apr 11 at 6:05 pm
There is a tendency to leave medical research to the big boys (especially the US) and for Australia simply to take up the innovations when they emerge.
Biomedical research is one area of research where the boast that “we punch above our weight” seems to hold true. For reasons unknown to me Aussies seem to do well at this stuff. I imagine Costello recognised that and sought to help it along because it represented good bangs for bucks.
Technically, he did not discover penicillin (that was Fleming) and all his research was undertaken in the UK (and some in the US).
Fleming did bugger all, he noted the mould killed bugs and never followed it up, it was Florey and Co who isolated the active component – penicillin. His principal research breakthroughs were in Britain, his team went to the USA to set up mass production programs. A huge and striking achievement because it made penicillin very widely available and this one instance saved so many thousands, tens of thousands of lives.
John H.
19 Apr 11 at 6:07 pm
There are a lot of ways a Government can encourage more research into medicine through laissez faire means.
One obvious way is being more liberal in regards to experimental drugs. This would speed up the process, wouldn’t it?
.
19 Apr 11 at 6:16 pm
“Conrad – one per cent, yes, looks modest but it is actually one percentage point. Health expenditure will grow 6.4 per cent per year rather than 5.4 per cent per year (estimated). I don’ think so”
Why not? Various well thought out campaigns have been amazingly successful in Australia in terms of public health, e.g., AIDs, skin cancer, smoking, and more recently, mental health and cervical cancer. Without them god knows how much more the health budget would be (and other associated costs, like what to do with fat depressed 55 year old males on disability pensions). And who knows where we would be if the idiotic anti-vaccination crew had no-one to argue against and we started getting more people with serious (expensive) disorders from childhood because of it.
Apart from this, we apriori know what the big issues will be in the future — one is weight, which I assume causes or will cause huge amounts to be spent (especially on the PBS), and the other is aging, which we know surprisingly little about (everybody has historically loved developmental research), and I can’t see why we shouldn’t get big improvements in both these areas. Saying that we won’t to me is pretty defeatist and also ignores the historical success some groups have had in terms of public health.
conrad
19 Apr 11 at 6:25 pm
“The need for some research-types to assimilate the benefits of overseas research is an interesting idea but is there any evidence for this?”
Yes, try comparing Australia to places that don’t do much medical research, and see where you get better care and better outcomes. Why is Australia a leader in mental health, for example, which is essentially free? At least part of the reason is that we have lots of smart people working on it that basically push the newer ideas via the organizations that deal with it such that the people that actually do the work with clients are obliged to use them. Another example is with IVF. Why is Australia a leader in this? Is it because we can just buy all the technology and instantaneously use it (any other rich country could do this), or is it because of interactions between people doing research and people offering the services? Surely it’s the second of these.
conrad
19 Apr 11 at 6:32 pm
One obvious way is being more liberal in regards to experimental drugs. This would speed up the process, wouldn’t it?
Given the number of drugs that have been recalled or issued with black box warnings over recent years liberalising drug research is hardly going to find much favour. The real costs in health is not about drug development per se, it is as Conrad suggested more relevant to wider public health issues like obesity, aging, and diabetes. These issues are really about personal behavior modification, not drugs.
John H.
19 Apr 11 at 6:41 pm
Australia is well-regarded the world over for the quality and depth of our health data, and have been central to the instigation and/or success of many well-known and not-so-well-known programmes.
One not yet mentioned – dietary folate (and supplements to be safe) for women planning/undergoing a pregnancy. The studies that established the link with huge reductions in spina bifida were not cheap, because huge amounts of data were required covering a wide geographical, socioeconomic and ethnic range.
Granted this is partly due to the fairly low incidence of the problem (versus say, obesity) but try making that argument to the parent of a child (usually stillborn) with SB.
FDB
19 Apr 11 at 6:45 pm
If $400 million yields benefits of $129 billion, we should divert the entire Australian GDP to medical research. (HT: Peter Costello)
Samuel J
19 Apr 11 at 7:06 pm
He probably copied that from me – I made that point several years ago in an analysis of the alleged returns to R&D.
Sinclair Davidson
19 Apr 11 at 7:09 pm
No doubt about that Sinclair!
Samuel J
19 Apr 11 at 7:14 pm
FDB – I understand that the link between folate ingestion and the incidence of spina bifida has now been overturned. Probably worth investigating but no cigar eventually.
One area in which there was an unequivocal advance was the link between lack of iodine and goitre/mental retardation. This was an Australian discovery and practical solutions were proposed by Australian researchers.
Australia has had a comparative advantage in virology eg. Mac Burnet and we should probably stick to this area. But medical research funds are really all over the shop.
Maybe Fleming didn’t understand what he had discovered but he was awarded the Nobel Prize, jointly, nevertheless. Fleming eventually outfoxed Florey in terms of gathering in the glory, but of course Fleming was British and Florey was not.
Judith Sloan
19 Apr 11 at 7:17 pm
For reasons unknown to me Aussies seem to do well at this stuff.
The Sister Kenny syndrome – the willingness to challenge orthodoxies and cause offence to a stuffy ‘consensus.’
C.L.
19 Apr 11 at 7:18 pm
Big freaking deal. Who gives a cracker what others think of us.
JC
19 Apr 11 at 7:20 pm
$400m is a bloody lot of money. It’s not good enough to point to IVF and Florey and Cochlear and so on – all in the distant past – then fold your arms and say “See? value for money.”
Here’s a parallel: historically we’ve been a world leader in tennis. Currently there is a lot of money in ‘tennis programs’ but we simply can’t cut it any more. The point being, historical success isn’t enough to justify current funding. Especially at a very, very high level.
daddy dave
19 Apr 11 at 7:25 pm
“FDB – I understand that the link between folate ingestion and the incidence of spina bifida has now been overturned.”
WTF? Got a link for that? There’s a huge amount of extremely robust research, which would take a shitload of overturning.
Maybe you’re thinking of the supposed link between folate supplements and colorectal cancer being shown to have no support.
Note: the folate-SB (inverse) link was my mum’s PhD topic, so while I know a fair bit about it, I may be biased!
FDB
19 Apr 11 at 7:27 pm
The multiplier is 322.5
.
19 Apr 11 at 7:31 pm
Down tools everyone and get into medical research. With a multiplier like that, we’ll all be RICH!
daddy dave
19 Apr 11 at 7:33 pm
“He probably copied that from me – I made that point several years ago in an analysis of the alleged returns to R&D”
Sinclair, I imagine there are diminishing returns. I also think, like Judith does: “But medical research funds are really all over the shop.”, so you could get more bang fo your buck if you could sort out who the NH&MRC gives money to (which IMHO would be essentially impossible). You’ll also note that, if you read the article claiming the 129 billion, the authors seem pretty keen to talk about preventative stuff, not the really crappy projects you can read about if you flick through the grants awarded. If you want the worst example of poorly directed money to complain about, then you could look at the national research priorities, one of which is astrophyics.
conrad
19 Apr 11 at 7:33 pm
$400m is a bloody lot of money. It’s not good enough to point to IVF and Florey and Cochlear and so on – all in the distant past – then fold your arms and say “See? value for money.”
Good point DD but …
The artificial skin made by the Fiona Wood, world breakthrough in the treatment of burns – a decade old.
The breakthrough in H.Pylori – ulcer link – recent.
Menzies Group has made some big strides in malaria research – recent and ongoing.
Another Aus doctor received a Nobel last year.
Qld Brain Institute – doing good stuff.
World class prostate research at Mater Hospital – Prof Hart. – ongoing.
CSIRO recently awarded 200 billion damages for Wifi technology stolen by some companies.
—
Research takes decades, it might seem smart to cut funding for one or two years but that means it stops here and there are plenty of overseas countries willing to adopt the research and the researchers. The stoppage of programs for funding purposes means the loss of that research for all time, it goes elsewhere.
John H.
19 Apr 11 at 7:36 pm
Oh I forgot, the above all off the top of my head. There must be much much more because I don’t follow any research anymore. For eg: there is a company in Aus doing brilliant research on cancer vaccines.
John H.
19 Apr 11 at 7:37 pm
“Here’s a parallel: historically we’ve been a world leader in tennis. Currently there is a lot of money in ‘tennis programs’ but we simply can’t cut it any more. The point being, historical success isn’t enough to justify current funding. Especially at a very, very high level.”
I guess by that analogy, we should stop runnning the prevantative medicine we’ve been super at doing to. oh well. I don’t think 400 million in context is a lot incidentally. Even if you got a 1 billion return, then that’s more than you’re spending. In addition, that number doesn’t even include the pain and suffering you might save people. For example, I doubt it’s fun to be obese for 30 years of your life (as you DD, that’s not me!), but, apart from medical and associated social costs, that hasn’t even been mentioned.
conrad
19 Apr 11 at 7:38 pm
Conrad:
What research is being done with the money that private investors can’t offer? I’m not talking about primary by the way.
JC
19 Apr 11 at 7:44 pm
I think the cut is $400 million over 4 years. My particular lab gets plenty of NHMRC funding but we also get funding from a diverse array of places including China and the Middle East. My PhD scholarship comes from the ARC though.
I won’t deny that ‘we’ medical scientists are rent seeking. That said, the $129 billion figure isn’t coming from scientists as far as I can tell.
I think in medical research there are several types of research – patient data collection, blue sky, basic investigation and product development.
I think the public purse should fund basic and some blue sky as it is a public good (though often not realised for decades)- the question of how much is one of public conscience. The product development is where the real cost/benefit thinking comes in, you can make a lot of money and researchers can hopefully fund their own R&D thereafter.
The patient data collection is very much local research and is boring, incremental and often not sexy but it needs to be done. Doctors in hospitals can do some very simple and effective studies. In my mind its this kind of science done by ‘run of the mill’ researchers that will be lost in funding cuts. Meanwhile the high flying stars in the field will survive…
Chumpai
19 Apr 11 at 8:00 pm
“What research is being done with the money that private investors can’t offer?”
Essentially all mental health research, most IVF research, most research on new antibiotics, research on many diseases that have comparatively few sufferers, research on tropical diseases, a lot of genetic research, most research on the effects of illegal drugs, etc. . There are of course private foundations that you can get some funds off, but only for some things (e.g., the most obvious being the Bill and Melinda Gates foundation who give tons of money for malaria and vaccinations campaigns).
I’m not saying that private investors can’t do a lot — they do. The big pharma companies create wonderful stuff, and I don’t see why you would ever bother doing research that they do.
conrad
19 Apr 11 at 8:00 pm
Also Conrad preventative medicine research can cost a lot of money as you often test it on mice beforehand. For example, vaccines (highly preventable medicine) or even diet (to test theories on asthma, obesity etc) these all require animal studies.
Chumpai
19 Apr 11 at 8:02 pm
Conrad;
I person I know has a foundation that supports research into stem cells other related stuff. Why would you assume that sort of thing wouldn’t happen more if the funding closed up.
Perhaps head researchers ought to hit the road more and talk to these people. Mind you US Foundations aren’t held captive on their own shores and regularly fund stuff overseas.
JC
19 Apr 11 at 8:05 pm
oops A person I know…
JC
19 Apr 11 at 8:06 pm
“Why would you assume that sort of thing wouldn’t happen more if the funding closed up.”
I think you’ll find that the funds don’t provide broad coverage of things — they tend to be targeted at a rather small number of areas, which certainly doesn’t preclude other areas being important.
conrad
19 Apr 11 at 8:17 pm
I think you’ll find that the funds don’t provide broad coverage of things — they tend to be targeted at a rather small number of areas, which certainly doesn’t preclude other areas being important.
The problem with public health related research is that it is about saving money, not making money. So private enterprises have little to gain by entering that field. The incentives aren’t there. For the government though the potential savings are huge.
John H.
19 Apr 11 at 8:21 pm
This is true… but that stuff is cheap to run, relatively speaking.
Preventative medicine, as you say, reaps dividends but again, relatively cheap.
Once you flood the system with money you get these massive labs appearing with lots of machines that go “ping!”, lots of internal mini-bureaucracies and bloat. And data trawling, of course, so they can justify the next round.
MRI springs to mind as the worst offender. There’s no value for money with MRI research.
daddy dave
19 Apr 11 at 8:24 pm
MRI springs to mind as the worst offender. There’s no value for money with MRI research.
Ya think, just two days ago overseas bods found a way to detect early Alz with MRI imaging. Given the associated research indicating potential reversal of Alz pathology, that has huge implications, especially as only a few days another piece of research indicated that a full decade before a diagnosis of Alz the brain has shrunk. So MRI has huge potential to identify Alz before it leads to serious cognitive impairment thereby allowing interventionist strategies that could reverse the initial pathology. The potential savings from that are enormous.
John H.
19 Apr 11 at 8:27 pm
Okay then, let’s agree that ‘public health’ broadly speaking, is an area that requires government assistance. But how much of our research expenditure is being spent on public health? I don’t know the answer, by the way.
And as Conrad says, perhaps we should think about our national research priorities… astrophysics doesn’t strike me as a particularly pressing need.
daddy dave
19 Apr 11 at 8:31 pm
considering the amount of MRI research that gets done and how much it costs, I’m glad they found something useful.
daddy dave
19 Apr 11 at 8:32 pm
hey DD,
Look, I know what you are getting at, there is far too much wasted money on stupid research issues. I see them every week but it is more prominent in fields like social psychology than biomedicine and some cognitive neuroscience(my bias, I think a lot of that is baloney). Medical related research requires a big net because there is no over arching theoretic construct to guide us. We stumble forward, looking for clues. Modern medicine is great but keep in mind it is great not because of some carefully designed research program but because of a lot of thrashing about.
John H.
19 Apr 11 at 8:35 pm
The problem with public health related research is that it is about saving money, not making money. So private enterprises have little to gain by entering that field.
But can’t private enterprise make money by providing potential savings to government?
dover_beach
19 Apr 11 at 8:45 pm
But can’t private enterprise make money by providing potential savings to government?
Perhaps but the savings come from changes in personal behavior, not products. I think Conrad is making a very important point about public health issues. It is not about some new whiz bang product, though in relation to obesity and diabetes that remains possible, it is more about initiatives to change personal behavior. Seriously DB, a lot of modern health costs, perhaps the greater bulk of it, is occurring because of bad personal habits. Says hypocrite John having just made his xth cup of coffee for the day …
John H.
19 Apr 11 at 8:49 pm
This seems to be the (lack of) basis of the $129 billion – if then but no basis for the if:
‘Since 1998, spending on Australian health services has grown each year by an average of 5.4 per cent. Expenditures of $107 billion in 2008-09 will rise to $226 billion in 2020 if this rate of growth remains steady,” the economists said.
”If spending increased 1 per cent more than 5.4 per cent due to poor health services decision making, then gross expenditures by 2020 will be $129 billion higher than $226 billion.
”There could also be worse health outcomes among the population.”
Read more: http://www.theage.com.au/national/economists-put-129bn-tag-on-cut-to-research-20110418-1dlp5.html#ixzz1JxtnxpIE
Samuel J
19 Apr 11 at 8:52 pm
John,
Maybe we’ve got a great thing going here in Australia, and it would be a shame to kill the golden goose. But whenever the government injects hundreds of millions of dollars into an industry, you’re going to get parasites (aka ‘rent seekers’), waste, and so on. It’s good to be vigilant.
daddy dave
19 Apr 11 at 8:53 pm
Samuel:
The growth mentioned is in nominal terms , yea?
JC
19 Apr 11 at 8:55 pm
“But whenever the government injects hundreds of millions of dollars into an industry”
I don’t think you should really think of it like an industry — you’re basically subsidizing a whole bunch of areas, some of which may potentially be useful to you in ways that are hard to predict — that’s why you put your eggs in lots of baskets (although there are obvious baskets where more eggs should be, like aging!). For example, when SARS turned up, I was lucky enough to be living in HK at the time. I was pretty happy there were people that knew a lot about viruses, the mathematical modeling of the spread etc. . These are all important things to know about (especially in one of the disease capitals of the world — Southern China), and so it’s good to have a few people obsessed with everything to do with the fundamentals of viruses that know what to do in novel situations.
conrad
19 Apr 11 at 9:01 pm
True DD. A big difference with a lot of scientific and technical research is that there are many hurdles to getting the project up and going. Nonetheless some stupid things happen. Consider the fiasco over the Qld Govts new payroll system for the Health Dept. The figures on that 200 million plus I think, for a software system that should basically be “off the shelf” confound me.
Having worked in the public service I think a big problem is when public servants source commercial contracts they are too often are out of their depth. I wonder if the tendering process should be outsourced because public servants often lack the private industry exposure to know how to wheel and deal. Consequently government contracts often are huge money spinners for private enterprises. Now you can’t blame the private enterprise for that, it is their business to make money, but examples like the above(and I suspect that stupid computers for kids program) highlight the inadequacies of public servants seeking to obtain good deals from private enterprise. Two examples from memory:
A friend did a short stint with the Gold Coast local council. He was advised that the tendering for the water department was farcical because the rules for tendering involved making bad choices.
A chap who worked in the old CES told me that when the job network was privatised he and a friend did the costings and realised they could make money hand over fist.
John H.
19 Apr 11 at 9:10 pm
it is more about initiatives to change personal behavior. Seriously DB, a lot of modern health costs, perhaps the greater bulk of it, is occurring because of bad personal habits.
JohnH, well, my instinct here is simply to tell the government to mind its own business. The only reason personal habits have fallen in the orbit of government is because it has chosen to bear the social costs. And since obesity and diabetes are not communicable diseases I don’t think they really fall within the scope of public health.
dover_beach
19 Apr 11 at 9:21 pm
And since obesity
It is communicable in the behavioral sense. This is very important in relation to obese parents and their children. In that sense the same can be true with diabetes because one leads to the other. That is an example where it gets very complex because there is no good data to show that obesity in childhood helps set the stage for future diabetes, atherosclerosis, and I’ve even seen British studies demonstrating direct impacts on cognition and accelerated brain aging from obesity. The big problem emerging there is the epigenetic implications: all these obese people having children may well be paving the way for their children being more susceptible to range of conditions. Hell, there is even data showing the sperm of obese fathers is somehow transmitting unpleasant developmental signals to the offspring. There goes the Weissman Barrier!
I’m glad that government didn’t mind its own business with respect to the AIDs crisis, Australia achieved a stunning win in that regard.
John H.
19 Apr 11 at 9:27 pm
Why on Earth would you spend $129bn on a bunch of taxeating science workers when there is not a single medical condition known to man that cannot be cured through the generous application of horse pills, household bleach and raw milk.
Tillman
19 Apr 11 at 9:27 pm
Out of a budget of ~$350 billion I’m not sure that cutting $400m from medical research over four years should be the highest priority on the list.
How about they start with seeking an ‘efficiency dividend’ from the ABC and the policy bureaucrats in Canberra. Might also allow the rest of the country to catch up with the miracle economy emerging in the ACT.
David
19 Apr 11 at 9:45 pm
Not to mention, Tillers, a regimen of exercise, porridge and cold showers.
Sinclair Davidson
19 Apr 11 at 9:48 pm
It is communicable in the behavioral sense.
What isn’t communicable in that sense?
I’m glad that government didn’t mind its own business with respect to the AIDs crisis, Australia achieved a stunning win in that regard.
Quite, but AIDs was literally communicable in the traditional sense and therefore I have no problem with the research or campaigns associated with its control, amelioration or hopeful eradication.
dover_beach
19 Apr 11 at 9:49 pm
What isn’t communicable in that sense?
Irrelevant, the fact that obese parents create germline issues for their offspring, and behavioral issues for their offspring, is relevant. The damage is done before the child even reaches school. What is relevant is that what is communicated to children here is a bad set of consequences for which the children are not responsible. You may demand the ideological position that govts mind their own business but when we now see increasing numbers of teenagers popping up with type 2 diabetes, almost unheard of amongst teenagers 30 years ago, tell me, what should be done about that? So let’s say the government says tomorrow: you’re on your own, pay for your medical care and treatment. Most of those families would go bankrupt within 5 years.
John H.
19 Apr 11 at 9:54 pm
Irrelevant, the fact that obese parents create germline issues for their offspring, and behavioral issues for their offspring, is relevant.
No, it is relevant, unless of course you want to provide the government with an excuse to manage every part of our lives. But, from the point of view of a clinician or GP, yes, it indeed maybe irrelevant.
You may demand the ideological position…
I’m not arguing that the government mind its own business in toto. I’m arguing that we draw a distinction between a public health problem and one that is essentially a private health problem. The fact that there are increasing numbers of teenagers with type 2 diabetes does not make it a public health problem per se.
dover_beach
19 Apr 11 at 10:04 pm
There might be a better return by cutting research funding in Australia and sending the savings to the United States to bolster its research efforts.
Samuel J
19 Apr 11 at 10:15 pm
No, it is relevant, unless of course you want to provide the government with an excuse to manage every part of our lives. But, from the point of view of a clinician or GP, yes, it indeed maybe irrelevant.
What is relevant here is that the consequences are heritable(both genetically and behaviorally) and bad. Your wish to delineate consequences based on the nature of the spread of a given pathology is too neat, it doesn’t work like that(you’re being irrationallly rationalist). It represents a problem for the greater community because type 2 diabetes gives huge risk spikes for: amputations, blindness, dementia, kidney disease, CVD. I did not argue that the govt regulate all our lives, I’m not even arguing the govt has to regulate this behavior, but it has to face up to the consequences that leaving these matters unattended will result in a huge spike in people becoming disabled and in the absence of govt sponsored health care lots of dead bodies. So tell me, if the government offers no health care for such people, how is this problem addressed? Do we just let them die? That is the most cost effective solution.
John H.
19 Apr 11 at 10:17 pm
$16 BILLION sunk into the Julia Gillard Memorial Gold Plated Tuck Shop roll out – which I think is still rolling ?
And they thought chopping medical research wouldn’t raise a whimper ?!
I am sorry – value-for-money issues aside – but I am with Niki Savva on this one. This is politics so dismal it is beyond ridicule.
Remember, this is the same Julia Gillard who a couple of weeks ago was loudly whistling her joy that the Labor tribe shares the values of Australian families, unlike – hem, hem – Bob Brown ( “loud metallic noise – here dog” ) ?
Families who coldly cut their sick, infirm and old off the lifeline are not generally regarded as role models. One wonders what sort of families she was talking about now ?
These people are utterly disconnected from the electorate – and are probably at the point where a lot of them actually need psychological counselling to restore human emotions and empathy.
And some are probably beyond saving and should be cut loose to drift away.
Myrddin Seren
19 Apr 11 at 10:31 pm
What is relevant here is that the consequences are heritable(both genetically and behaviorally) and bad.
They could have ‘inherited’ the relevant behaviour from someone other than their parents.
Your wish to delineate consequences based on the nature of the spread of a given pathology is too neat, it doesn’t work like that(you’re being irrationallly rationalist).
I’m not delineating consequences. I’m distinguishing a public from a private health matter.
It represents a problem for the greater community because type 2 diabetes gives huge risk spikes for: amputations, blindness, dementia, kidney disease, CVD.
This is not a problem for the greater community; it is a problem for those with type 2 diabetes, their relatives, and friends.
So tell me, if the government offers no health care for such people, how is this problem addressed? Do we just let them die? That is the most cost effective solution.
So the choice is government health care or no health care at all? The problem is principally addressed by they themselves addressing their own behaviour.
dover_beach
19 Apr 11 at 10:33 pm
I am sorry – value-for-money issues aside – but I am with Niki Savva on this one. This is politics so dismal it is beyond ridicule.
I agree. We’re quibbling over chump change considering the billions these clowns squandered over the last 4 years.
dover_beach
19 Apr 11 at 10:35 pm
“Do we just let them die?”
…
“they themselves addressing their own behaviour”
That’s a yes, John.
Uncharacteristically forthright there Dover.
FDB
19 Apr 11 at 10:42 pm
Judith – I’m pretty sure you were wrong about folate-preventative-of-SB being disproven by the by. At least my mum’s heard nothing.
FDB
19 Apr 11 at 10:44 pm
That’s a yes, John.
So they can’t change their behaviour? Or at least you believe they cannot. Interesting, you believe public education campaigns are wasteful.
dover_beach
19 Apr 11 at 10:48 pm
Judith – I’m pretty sure you were wrong about folate-preventative-of-SB being disproven by the by. At least my mum’s heard nothing.
The hospitals are still recommending folate. The recommendation is pretty much universal, at least, across Melbourne’s various private and public health options.
THR
19 Apr 11 at 10:49 pm
That’s a yes, John.
Yes, that is the best solution for society. Now ask yourself, how many people will support a government that let’s people die in the streets? That’s the problem with modern democracies, they are too benevolent for their own good. I wonder what would be the consequences of societal standards when it is run by a government that lets people die in the streets. If people argue that abortion cheapens life then surely this standard of leaving the disabled to their fate must make human life not only cheap but demand that it be expendable on a wide scale.
John H.
19 Apr 11 at 10:53 pm
Some good advice on here, I’m into porridge and cold showers. Exercise not so much but I have a regimen of work.
Keep hearing this…. these guys did not establish this link, it was already known decades before. The medical profession is very slow to respond and the two Australian doctors that effectively re-discovered the earlier knowledge had to forcefully convince the medical profession their current belief and treatment of stomach ulcers was crap. That’s still a big achievement but they didn’t make the original discovery.
Chris M
19 Apr 11 at 10:54 pm
Chris M – good point.
Mavericks are important too, and unlikely to attract funding. But it’s a slur on the work of Whatsisname and Warren that they merely “rediscovered” earlier work.
The problem was, the earlier work showed no link.
FDB
19 Apr 11 at 11:07 pm
We could end that by banning sugar and launching a class action against the government for poisoning the poulace with its evil food pyramid.
Infidel Tiger
19 Apr 11 at 11:07 pm
Now ask yourself, how many people will support a government that let’s people die in the streets?
No one will die in the streets.
That’s the problem with modern democracies, they are too benevolent for their own good.
This has nothing to do with benevolence. Benevolence could attend to the needs of those with type 2 diabetes through the efforts of private organisations like charities, NGOs, etc.
I wonder what would be the consequences of societal standards when it is run by a government that lets people die in the streets.
I wonder about the strength of your argument when it depends upon such fantastic images.
If people argue that abortion cheapens life then surely this standard of leaving the disabled to their fate must make human life not only cheap but demand that it be expendable on a wide scale.
Who is leaving the disabled to their fate?
dover_beach
19 Apr 11 at 11:07 pm
“Interesting, you believe public education campaigns are wasteful.”
Interesting, you believe public education campaigns exist independently of medical research.
No wait, that’s a bit sad and boring, really.
FDB
19 Apr 11 at 11:09 pm
This has nothing to do with benevolence. Benevolence could attend to the needs of those with type 2 diabetes through the efforts of private organisations like charities, NGOs, etc.
That’s a wish. It costs far too much for such organisations to attend to such people. They can’t do it now, they’ve never be able to meet the demand in the past. Without government support people will die. People will type 2 diabetes are disabled, they need constant medical supervision. Type 2 diabetes is looming, if not already, as single biggest cost for any pathology.
John H.
19 Apr 11 at 11:21 pm
Interesting, you believe public education campaigns exist independently of medical research.
Do I?
No wait, that’s a bit sad and boring, really.
Yes, your verballing is.
dover_beach
19 Apr 11 at 11:23 pm
It costs far too much for such organisations to attend to such people.
Really, it costs too much to deal with type 2 diabetes in its early stages? When exercise and changes in diet are effective? Do you really think I know no body that is presently dealing with it in its early stages?
dover_beach
19 Apr 11 at 11:30 pm
Dover, if your Mum gets a PhD, maybe you’ll be able to contribute more credibly.
Humility, brother.
C.L.
19 Apr 11 at 11:31 pm
Sorry D_B, this is a discussion about medical research funding, and the role of same in informing the public health education you mentioned is plenty relevant.
Where is education without information? Where is information without research?
I’m sure you see the problem.
I’ll repeat the sorry, this time to be clear that it’s for verballing you.
FDB
19 Apr 11 at 11:36 pm
Really, it costs too much to deal with type 2 diabetes in its early stages? When exercise and changes in diet are effective? Do you really think I know no body that is presently dealing with it in its early stages?
Yes, it does. Diet and exercise can reverse the condition but that can take months, during which time the patient may be on multiple medications, is experiencing retinal atrophy, athersclerotic plaque build up, amyloid accumulation, kidney damage, and there is no guarantee that diet and exercise will reverse the condition. Once it is established it can be difficult to reverse. The retinal atrophy(diabetes is the leading cause of blindness) is irreversible and sets the stage for early onset AMD, the athersclerotic plaques will remain(though there is some tantalizing evidence these plaques can be reduced), the amyloid accumulation will be irreversible(at least in the absence of specific strategies that at present *appear* to enable amyloid scavenging). The big problem here is that until the last 20 years no-one really paid much attention to type 2 diabetes because it was not a common condition. Just the other day I read one claim, which I regard with suspicion, that one in ten USA citizens have type 2. That is a disaster. If it were easily reversible we shouldn’t be seeing these ever increasing incidence rates. In a nutshell, type 2 diabetes is a massive increase in the aging rate. That a person has reversed the condition does not mean they have reversed the long term consequences. For example, both retinal atrophy and amyloid accumulation set up vicious cycles of pathology the full consequences of which may take many years to become apparent.
Oh I forgot: there is now evidence that retinal atrophy, present in everyone over 50, can be reversed to some degree. Patents are on the compound but it is simply a mix of 3 compounds you can buy at a health food store.
I don’t like this wish fulfillment idea I see expressed here so often that goes like this: If government gets out of the way everyone will become kum by ah and altruism will go through the roof. People are intrinsically selfish and if you think govt getting out of the way is going to change that you’re off with the hippies.
John H.
19 Apr 11 at 11:46 pm
Sorry D_B, this is a discussion about medical research funding, and the role of same in informing the public health education you mentioned is plenty relevant.
Yes, and I haven’t opposed government funding of medical research in toto and medical research undertaken without public funding conducted in universities, etc. could itself form the basis of public education campaigns. “I’m sure you can see the problem”, but maybe not; where is wisdom without modesty, where is modesty without wisdom.
dover_beach
19 Apr 11 at 11:49 pm
Yes, it does.
All you’ve shown is that it may in some but not in all cases.
If government gets out of the way everyone will become kum by ah and altruism will go through the roof.
I don’t believe that. And I’m prepared to alter my position viz. its potential to be a public health problem if the circumstances themselves warrant such an alteration.
dover_beach
19 Apr 11 at 11:58 pm
All you’ve shown is that it may in some but not in all cases.
What I have shown is that the increasing incidence and costs of type 2 diabetes indicates that the ratio is towards ever increasing costs being incurred. That trend is clear, it is a huge issue for governments and at present there is no evidence the trend is declining. If it does, and I hope it does, well and good. But in the absence of any evidence that related health care costs for type 2 diabetes are declining I can’t wish for a turn around. It is already a major health problem. Type 2 can exist for some years prior to diagnosis, by which time multiple downstream consequences have done their nasties and paved the way for future problems.
The evidence for it being reversible is weak. Type 2 is an inflammatory state, very hard to reverse. As the following indicates, many already regard this as a major public health issue.
…
1. Acta Diabetol. 2010 Jun;47(2):137-45. Epub 2009 Aug 5.
…
As far as secondary and tertiary prevention is concerned, for persons already diagnosed with diabetes, there is limited evidence of the effectiveness of diet or lifestyle modification on glycemic control, but further studies are necessary.
PMID: 20703436 [PubMed - indexed for MEDLINE]
…
The public health burden of type 2 diabetes mellitus has been dramatically increased worldwide. Not only its prevalence rate at present but the increase of its incidence in the near future can create a global health problem. The rapid increase of the total number of newly diagnosed diabetic patients proved to be associated with the increasing prevalence rate of obesity. The metabolic syndrome and type 2 diabetes can contribute to accelerated atherosclerosis and, therefore, the target organ damages can carry a serious problem for the individuals and also for the whole society.
PMID: 14598569 [PubMed - indexed for MEDLINE]
This from a 2001 review, when they were already sounding alarm bells.
..
The review of several diabetes … is the fourth or fifth leading cause of death in most developed countries. Diabetes prevalence ranges from nearly 0% in New Guinea to 50% in the Indians of Arizona. … Diabetes affects almost all organs of the body and is the leading cause of blindness and amputations of legs, imposing both clinical and economic costs to patients and society.
PMID: 11561471 [PubMed - indexed for MEDLINE]
John H.
20 Apr 11 at 12:24 am
D_B, I don’t want to wade into your discussion with John, but please remember that with many major public health problems (diabetes is a classic e.g.) we are only seeing their effects as a result of our improved life expectancy – itself resulting from prior medical research.
Not that long ago, someone with stage 2 diabetes would just die, and the nuances of how to manage their condition would be kinda moot.
FDB
20 Apr 11 at 12:35 am
The figures are rubbish.
$107B at 5.4% compound over 11 years is 212B – not 226B
At 1 percent more:
$107B at 6.4% compound over 11 years is 240B – not 226B +129B = 355B just ridiculous, out by 115B, that is an error of 48%
These figures are supposed to be from a health economist.
If this is the state of medical research in this country it is a wonder we are not all dead.
TJ
20 Apr 11 at 1:45 am
I get $190.82 billion @ 5.4% for 11 years compounded.
I also get 212.7 @ 6.4%
Still he’s wrong and ought to be out of a job if he can’t publish correct figs.
JC
20 Apr 11 at 1:56 am
If preventative medicine is so effective, why is the health budget still growing at a rapid rate?
boy on a bike
20 Apr 11 at 6:06 am
“If preventative medicine is so effective, why is the health budget still growing at a rapid rate?”
Population growth, aging, increases in salaries of medical workers, increases in various things that cause big increases in costs (fattening), and increases in the ability to keep alive longer (including expensive new drugs).
I think what a lot of this debate shows here and elsewhere is that people don’t understand the cost of things that compound over the long term.
conrad
20 Apr 11 at 7:15 am
Not research, but as in preventative medicine, they are highly valuable. The accuracy and ubiquitousness of prostate examinations would increase greatly if every GP had quick access to an MRI machine. So says my med imaging friend. There would be a gain in lives saved and money not spent on palliative care, as well as unnecessary biopsies.
.
20 Apr 11 at 7:38 am
Galloping bureaucratitis! It’s a global pandemic without a cure.
Paul Williams
20 Apr 11 at 8:09 am
JohnH:
What I have shown is that the increasing incidence and costs of type 2 diabetes indicates that the ratio is towards ever increasing costs being incurred.
Firstly, I haven’t suggested anything about trends in respect of costs and its worthwhile asking is their a trend of costs declining in terms of any of the conditions we may be subject to? Secondly, wouldn’t the impetus felt by the government to invest in research here also be felt by private health insurers? (I’m thinking aloud here) The principal impetus for government to invest in medical research is to manage potential future costs.
It is already a major health problem….as a major public health issue.
I agree, its a major health problem. I not sure its a public health problem.
FDB:
D_B, I don’t want to wade into your discussion with John, but please remember that with many major public health problems (diabetes is a classic e.g.) we are only seeing their effects as a result of our improved life expectancy – itself resulting from prior medical research. Not that long ago, someone with stage 2 diabetes would just die, and the nuances of how to manage their condition would be kinda moot.
Yes, I understand that, FDB. All of which makes me suspicious of claims that these are public health issues.
dover_beach
20 Apr 11 at 8:17 am
Let me rephrase the question then:
If preventative medicine is so effective, why are more and more people still getting fat – and getting fatter than fat people in the past(thus pushing medical costs up at a fast rate)?
boy on a bike
20 Apr 11 at 9:43 am
I reckon it’s the moral hazard of Medicare.
.
20 Apr 11 at 9:49 am
Yes, that’s certainly part of it.
dover_beach
20 Apr 11 at 9:54 am
“If preventative medicine is so effective, why are more and more people still getting fat”
Because people haven’t worked out how tackle weight gain — it’s not as simple as other areas (e.g., smoking) — and previous approaches have pretty much failed (e.g., Life be in it). If you’re interested, another area which is really hard to tackle is safe-sex in groups over about 30 — this is because the typical “this will kill you campaign” for smoking and driving doesn’t work with them presumably because they already know the consequences. These are both good examples of why you need research into methods that might potentially modify behavior incidentally, and where any method that worked would save you oodles.
conrad
20 Apr 11 at 10:16 am
Perhaps we need to distinguish between preventative medicine where precursors to disease are discovered, versus “preventative medicine” which is basically about social engineering us away from known risks.
Decreasing bad cholesterol prevents heart disease. Increasing folate prevents spina bifida.
Cervical vaccinations prevent cervical cancer.
These links were unknown a century ago.
Then there’s the stuff we already know is bad for us, lik eating fast food, riding bikes without helmets, drinking, smoking, staying up late, swimming outside the flags and so on. “preventing” risky behaviour is not the same as preventing cervical cancer.
daddy dave
20 Apr 11 at 10:19 am
Should the goal be to modify behaviour? It’s not black and white. on the one hand you have cervical immunization, flu shots, and washing of hands. These are all behaviours that prevent disease.
it’s a spectrum between this and the lifestyle nazis. Where is the line?
daddy dave
20 Apr 11 at 10:21 am
“Where is the line?”
If you want to go broke paying for fat people, type II diabetes, heart-disease drugs, pensions for people whose brains have holes in them after strokes etc., then keep the line where it is today.
conrad
20 Apr 11 at 10:28 am
Should the goal be to modify behaviour?
Well, to the extent that the behaviour concerned is a risk to public health, then yes, but no, if it is only a risk to us privately.
dover_beach
20 Apr 11 at 10:29 am
If you want to go broke…
Hello? “I reckon it’s the moral hazard of Medicare.”
dover_beach
20 Apr 11 at 10:30 am
I should say that the worst is yet to hit us — wait for a decade or two until people who have been obese for most of their lives get older
http://www.abs.gov.au/ausstats/abs@.nsf/0/4DE3C28315518DCECA25732C002074E4?opendocument
“I reckon it’s the moral hazard of Medicare.”
Unless the government wants to stop any funding of public doctors, pensions etc., you can complain all you want about this.
conrad
20 Apr 11 at 10:33 am
If we stopped paying for obesity related diseases, wouldn’t those affected modify their behaviour, and thus there would be a decrease in such disease?
Paul Williams
20 Apr 11 at 10:36 am
BTW, the costs of medicine will increase inexorably even with changes in behaviour simply because we are living longer. The people I know that are in the early stages of type 2 diabetes are all over 70, are not obese, are relatively active, do not eat fast food, etc. One has a family history involving diabetes, the other doesn’t.
dover_beach
20 Apr 11 at 10:36 am
This isn’t as bad as it is made out. BMI is bullshit and everyone knows it.
Michael Jordan was ‘obese”.
Michael freaking Jordan.
http://www.youtube.com/watch?v=OD54eF2XKJA
.
20 Apr 11 at 10:38 am
Unless the government wants to stop any funding of public doctors, pensions etc., you can complain all you want about this.
Surely you meant to say: Sorry we got you into this.
BTW, this is the ‘mutual obligation’ of the future.
dover_beach
20 Apr 11 at 10:44 am
dd
Slightly O/T, but relevant
Might not that be accounted for by the fact that back in Australia’s hey day, 90% of the world’s population either lived on a sampan, was starving in Africa, or behind the iron curtain. Since 1980, billions of people have been lifted out of poverty, with an especial explosion in the middle class. In other words, right before Australia’s eyes the credible market for star tennis players multiplies by about 100 times.
I don’t think quite the same has happened in medical research. Though maybe it has. How much did Israel, China, Indian, Mexico, and Brazil spend on medical research in 1980 compared to today?
Peter Patton
20 Apr 11 at 11:08 am
BigPharma does bugger all scientific medical research. It just buys the success stories from lower down the chain.
For BigPharma, R&D means marketing, which is what they spend all their “investment” funds on.
Peter Patton
20 Apr 11 at 11:15 am
I reckon it’s the moral hazard of Medicare.
India has soaring type 2. Interesting epigenetic possibilities there. I seriously doubt those people are getting fat and expecting the government to address their problems. Nor is type 2 just about obesity. There is evidence that some common pollutants in our bodies have significant impacts on processes that promote type 2. As this review article notes:
Nat Rev Endocrinol. 2011 Apr 5.
…
Although more experimental work is necessary, evidence already exists to consider exposure to EDCs as a risk factor in the etiology of type 2 diabetes mellitus and other diseases related to insulin resistance.
PMID: 21467970 [PubMed - as supplied by publisher]
Given the widespread prevalence of EDCs we can no longer assume that obesity alone is the problem. We are creating environments that promote a some big chronic pathologies(CVD, dementias). For example, a recent study found mice exposed to traffic pollution ended up with shrinking brains. An Aus study last year advised pregnant women to stay away from main roads because of slight reduction in fetal size relative to exposure.
Also …
Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes?
…
Supporting this hypothesis, cross-sectional investigation of background exposure to POPs in the National Health and Nutrition Examination Survey showed relationships similar to those observed for GGT, including a powerful association with prevalent diabetes and no association between obesity and diabetes for very low POP concentrations. Our hypothesis can be tested in both prospective studies and toxicological studies.
—
Given these recent findings it does become a public health issue because the implication is that POPs are playing a major role in driving type 2. Thus while many think it is just about poor diets and obesity, there is now evidence that it is much more complex than that. Given that we are literally pouring POPs into the environment, that all of us have measurable levels of POPs in our bodies, we are faced with an ecological issue that suggests if we persist in our polluting behavior we will not only increase type 2 but also CVD, dementias, and other inflammatory related conditions. .
The accuracy and ubiquitousness of prostate examinations would increase greatly if every GP had quick access to an MRI machine.
There is still furious debate over whether prostate cancer should ever be subject to screening.
John H.
20 Apr 11 at 11:35 am
Obesity. How to tackle it.
We already have a system in place where high income earners have their arms twisted to buy private health insurance.
Why not set a weight threshold or BMI threshold – over that limit, you get your (flabby) arm twisted to buy private insurance.
The private insurers should be free to add a risk premium to those accounts. Big fat flubbards will have to pay more.
If you’re fat and poor and have trouble paying the extortionate premiums? Well, I guess you’ll have no money to buy food for a while, so the problem should self correct after you’ve starved for a few months. Or you can liposuction out some fat and sell it for the making of soap (ala Fight Club).
boy on a bike
20 Apr 11 at 11:35 am
They’re also getting richer.
Man’s burden. Dare to suggest the same thing for breast cancer. MRI would make the efficacy increase so much that the screening would be worth it.
.
20 Apr 11 at 11:39 am
POPs?
dover_beach
20 Apr 11 at 11:44 am
Given these recent findings it does become a public health issue because the implication is that POPs are playing a major role in driving type 2
That makes persistent organic pollutants (POPs) a public health issue; not type 2 diabetes, etc.
dover_beach
20 Apr 11 at 11:48 am
Hilarious! Muslim Malaysia is packing off proto turd burglars off to butch camp to learn how to man up. Here’s some advice. Make the chicks wear bikinis, rather than shower curtains.
An “anti-gay” camp? Benny Hill couldn’t have come up with a better name!
Read more: http://www.smh.com.au/world/effeminate-schoolboys-sent-to-antigay-camp-20110420-1dnvk.html#ixzz1K1X26UEP
Peter Patton
20 Apr 11 at 11:49 am
I LOL’d hard.
.
20 Apr 11 at 11:55 am
POPs?
Persistent Organic Pollutants. Every-bloody-where. These types of findings rarely reach the mainstream media, most people have no idea of the research into these pollutants. The relevant study mentioned in that abstract attracted a lot of attention last year, overseas, because it indicated that POPs concentrations were a bigger risk factor than obesity. I don’t accept that but it does suggest that the current rates of type 2 does involve POPs. As we continue to throw POPs into the general environment we are creating an epidemiological time bomb. Most people have heard of Bisphenol A but it is one in a large class of compounds. There is no known way to eliminate POPs from bodies.
John H.
20 Apr 11 at 11:56 am
Oh look just what popped up in the news …
http://www.bbc.co.uk/news/health-13119545
A mother’s diet during pregnancy can alter the DNA of her child and increase the risk of obesity, according to researchers.
The study, to be published in the journal Diabetes, showed that eating low levels of carbohydrate changed bits of DNA.
It then showed children with these changes were fatter.
The British Heart Foundation called for better nutritional and lifestyle support for women.
It is thought that a developing baby tries to predict the environment it will be born into, taking cues from its mother and adjusting its DNA.
Epigenetics
….
John H.
20 Apr 11 at 12:05 pm
I’ll guarantee they eat bread, rice and pasta, thus slowly poisonong themselves following the government’s insane food pyramid, based on worse junk science than the global earming lie.
Diabetes and obesity are the most easily prevented conditions – eliminate carbs and you’ll be right. sport.
Infidel Tiger
20 Apr 11 at 1:24 pm
Now this is fascinating. Once you have B cell memory, you’re pushing shit uphill to stop that. In fact it is highly unlikely that this can be extinguished. A type of autoimmune response. This may also cast light on why type 2 can lead to type 1 diabetes. In relation to POPs it is worth remembering that fat cells are the major storage area of toxins, this may be playing a part in driving the autoimmune response.
http://www.nlm.nih.gov/medlineplus/news/fullstory_111085.html
SUNDAY, April 17 (HealthDay News) — New research suggests that the development of insulin resistance and type 2 diabetes may be linked to an immune system reaction gone awry.
…
Nearly 26 million Americans have diabetes, according to the U.S. Centers for Disease Control and Prevention. Between 90 percent and 95 percent of these cases are type 2 diabetes, where the body doesn’t use insulin efficiently, so the pancreas must make increasing amounts of insulin. Eventually, the pancreas stops making enough insulin to meet the increased demand.
…
And, that’s what got the researchers searching for another factor. Winer explained that excess weight has been linked to inflammation, which can cause the immune system to react.
John H.
20 Apr 11 at 1:35 pm
Neither, I think, eat much bread, pasta or rice. It’s in their diets but not overly. If anything, they both over-do their fruit and veg.
dover_beach
20 Apr 11 at 1:37 pm
I’m sure there was some research done a few years ago on babies born in the Netherlands during WW2 – where mothers were starved during pregnancy. They were fatter and higher death rates when young.
Tim Quilty
20 Apr 11 at 1:42 pm
Big mistake. Fruit is terrible for humans. Full of fructose which will mess with you as much as a candy bar. They need protein and fats in their diets.
Look at nature – who are the muscular and lean animals? The carnivores. Who are the fat shits? The herbivores.
Tell them to get hold of anything Gary Taubes has written before it’s too late. Diabetes can be reversed and quite quickly.
Infidel Tiger
20 Apr 11 at 1:43 pm
naturally I agree with IT as I’ve been pushing the whole evo fitness/quasi-Atkins stuff for a while. I haven’t cut out all carbs, I think if you live an active lifestyle you can afford to eat more than if you’re completely sedentary. But certainly people eat more processed junk, carbs, sugars than needed or is healthy and the whole ‘eat lots of fruit’ line is also another massive stuff up by the public health incompetents. fructose is basically as bad as plain old sucrose so keep it to moderate levels.
the best way to sum it up is basically you should only eat what you can imagine killing/fishing/plucking yourself in a forest with minimal processing.
jtfsoon
20 Apr 11 at 1:48 pm
I’m sure there was some research done a few years ago on babies born in the Netherlands during WW2 – where mothers were starved during pregnancy. They were fatter and higher death rates when young.
True, even studies indicating that if the grandparents went through a famine higher risk of diabetes. This is an epigenetic issue and helps explain the India situation.
Neither, I think, eat much bread, pasta or rice. It’s in their diets but not overly. If anything, they both over-do their fruit and veg.
Yes, as that news article I just put up indicates, the situation is much more complex than just diet. As we age we accumulate toxins, hence increasing inflammatory status with age. So for older lean people on good diets and lifestyle the target may be to look at the autoimmune possibility. However it is near impossible to reverse an autoimmune condition. A bone marrow transplant might do the trick but that is a very expensive and particularly for older people dangerous. They would probably better off managing the condition than going down that road. Perhaps, just perhaps, boosting vitamin D status may help limit the autoimmune and inflammatory component.
John H.
20 Apr 11 at 1:49 pm
Cheers, guys.
dover_beach
20 Apr 11 at 1:53 pm
IMHO Japanese cuisine is one of the healthiest of all (and also possibly my favourite – I love it because it relies mostly on bringing out natural flavours). It does have rice in it but it’s the standard one small bowl of rice you get with a bento which I think is a reasonable enough portion and possibly the most rice you might want to have in a single meal.
jtfsoon
20 Apr 11 at 1:57 pm
Even if you lucky enough to have a pancreas that can handle the insulin dose that carbs bring on,
I’d urge people to read some of Gary Taubes work. The anthropological studies he details on native American, African and aboriginal peoples being introduced to the western diet are fascinating. The science that led to fats being demonised will make you tear your hair out.
Wish I’d known this ten years ago.
Infidel Tiger
20 Apr 11 at 1:57 pm
It’s wrong wrong wrong. No athlete takes it seriously, or have since the mid 1990s…
.
20 Apr 11 at 1:58 pm
‘eat lots of fruit’
Two pieces a day is not a lot of fruit. AS for carbs, it may be more the source of carbs … wheat. The cardiologist on the Heart Scan Blog reckons wheat is close to poison.
John H.
20 Apr 11 at 2:00 pm
And yet it’s still the diet pushed on school kids and the obese. I think it’s a scandal.
Infidel Tiger
20 Apr 11 at 2:01 pm
and even now ‘excess’ protein gets demonised for kidney failure. I betcha 99% of the population does not consume enough protein for this to be a consideration
jtfsoon
20 Apr 11 at 2:05 pm
Fruit is fine. Western food is fine. It is the ratios of food types and calorific loads that matter. That and breaking up meals.
.
20 Apr 11 at 2:09 pm
You have to eat craploads of protein for that to ever happen – and not do any training.
.
20 Apr 11 at 2:09 pm
Most nutrition advice suffers from the ecological fallacy. Varying physiologies and lifestyles require varying diets. There is little point in talking about the right diet for everyone. Some people thrive on what appear to be bad diets. For example, I recall reading that for people who carry some alleles for APOE, it don’t really matter what they eat their risk of heart disease and obesity is very low. There is evidence that people of Asian descent need to more careful with their carb intake. Indigenous people suffer very high rates of illness when they move to Western foods. I have long suspected that some major health issues with Aus aborigines relates to their being the most genetically isolated group of humans. Some decades ago there was the claim that if you put aborigines back on a “bush diet” they demonstrated a remarkable recovery. So if they are that anxious about retaining their culture they should start with a bush diet. No, I am not being sarcastic.
If there is one thing that has surprised me over the last few years it is the “fine tuning” capacity of evolutionary processes. It appears to happen much more quickly and with more subtlety than we have previously surmised.
John H.
20 Apr 11 at 2:17 pm
Can you explain the thing about having too much vitamin A?
I remember I talked about how the “Optimum Nutrition Bible” recommended to basically double RDIs but you said not to go past that for Vitamin A…IIRC.
.
20 Apr 11 at 2:20 pm
Can you explain that or is it a typo? Reason I ask is that generally Asian cultures developed intensive agriculture earlier so you’d think they’d have more time to adapt to high carb loads. Whereas it makes sense that say, Aboriginals would find carbs bad for them since they spent most of their history eating animals they hunted
jtfsoon
20 Apr 11 at 2:21 pm
I guess the *varying physiologies* kind of means we ought to get some analytical chem done on our blood/urine and adapt our diets as necessary?
.
20 Apr 11 at 2:21 pm
Asian diets are typically very low in sugar. But look at the Chinese kids coming through now – fatty boom bahs who love their sweets like good spoilt boys.
Infidel Tiger
20 Apr 11 at 2:27 pm
Good point Jason, the elevated risk of impaired glucose tolerance may relate to Asians on Western diets with high saturated fat intake as saturated fat in itself can boost inflammation. Note though that it is the level of boost, the current craze to reduce inflammation as much as possible ignores its vital role in wound repair, initiating immune responses, and heaven knows what else. The below study suggests that southern Asians are at greater risk for impaired glucose tolerance.
You’re a brat Jason, you created a quandary for me.
1. Ethn Dis. 2010 Summer;20(3):225-30.
Elevated risk of type 2 diabetes and metabolic syndrome among Asians and south
Asians: results from the 2004 New York City HANES.
Rajpathak SN, Gupta LS, Waddell EN, Upadhyay UD, Wildman RP, Kaplan R,
Wassertheil-Smoller S, Wylie-Rosett J.
Department of Epidemiology and Population Health, Albert Einstein College of
Medicine, Bronx, NY 10461, USA. [email protected]
OBJECTIVE: Although numerous studies have identified an elevated risk of diabetes or impaired fasting glucose among Asians, there are limited data examining variability in risk among Asian subpopulations. We estimated prevalence of diabetes (DM), metabolic syndrome (MS) and impaired fasting glucose (IFG), by race/ethnicity and by Asian subgroup. DESIGN, SETTINGS AND PARTICIPANTS: This study was conducted using the fasting subsample of the 2004 New York City Health and Nutrition Examination Survey (NYC HANES; n = 1,324), a local version of the NHANES. Using country of origin information, we constructed South Asian and other Asian categories. MAIN OUTCOME MEASURES: DM, MS and IFG. RESULTS: Age-standardized prevalence estimates of DM, MS and IFG were 10.8%, 13.3% and 21.4% among Whites, 16.1%, 12.0% and 32.4% among all Asians, and 35.4%, 17.7% and 15.9% among foreign-born South Asians, respectively. After adjusting for potential confounders, Asians had significantly higher odds of prevalent IFG (Adjusted odds ratio [AOR]:2.64; 95% confidence interval [CI]: 1.60-4.38) and MS (AOR:2.09; 95%CI: 1.19-3.68), compared to Whites. South Asians were more likely to have DM (AOR:4.88; 95%CI: 1.52-15.66) and MS (AOR:5.59; 95%CI: 1.69-18.50) compared to Whites, while other Asians were at increased prevalence of IFG (AOR:2.89; 95%CI: 1.65-5.07). CONCLUSION: Our findings suggest that the observed White/Asian disparity in DM risk may be primarily attributable to elevated risk among South Asians.
PMID: 20828094 [PubMed - indexed for MEDLINE]
I guess the *varying physiologies* kind of means we ought to get some analytical chem done on our blood/urine and adapt our diets as necessary?
It is but as I previously stated DOT I am increasingly confused about a lot of this. Consider a recent British study which asserted that having a poor social life carried a health risk similiar to smoking 15 cigs a day. Nonetheless for those so inclined, and doctors can provide these tests, it is a good idea to have a HBA1c done. This test measures hemoglobin glycation – sugar coating, a good marker of long term sugar control. Vitamin D status is worth checking occasionally, keep it high. CRP – C reactive protein, while controversial, if persistently elevated, may indicate problems.
John H.
20 Apr 11 at 2:43 pm
It gets even worse …
Ha! Years ago I read a British study which suggested that there was a strong association between obesity and ADHD. This is a recent update:
…These data suggest that the offspring of obese pregnancies may be at increased risk of cognitive problems and symptoms of attention deficit hyperactivity disorder in childhood, eating disorders in adolescence and psychotic disorders in adulthood. Given the limitations of existing data, these findings warrant further study, particularly in light of the current worldwide obesity epidemic….
PMID: 21414129 [PubMed - in process]
John H.
20 Apr 11 at 2:56 pm
John, there’s quite a few reseachers convinced that sugar consumption is a leading cause of cancer. All theory at the moment, but it would explain why cancer was so rare amongst non-Europeans until sugar and flour was introduced to their diets.
Infidel Tiger
20 Apr 11 at 3:14 pm
The metabolism thesis is gaining ground, is that correct?
.
20 Apr 11 at 3:16 pm
John, there’s quite a few reseachers convinced that sugar consumption is a leading cause of cancer. All theory at the moment, but it would explain why cancer was so rare amongst non-Europeans until sugar and flour was introduced to their diets.
My understanding that is cancer is rare in animals. If it were just about sugar I would expect associations between animal diets and cancer. Some birds should get cancer by the flock load.
Sugar does figure prominently because some cancers have disabled\attenuated mitochondrial function and so rely on sugar as the only available fuel source. Eliminating or strictly controlling sugar intake is a good idea. Carbs are another issue here. Humans can’t convert fat to sugar but can readily convert carbs to sugar.
I consider the most appropriate acronym in health is AGE products: Advanced Glycation End Products – which refers to sugar molecules binding other molecules and causing conformational changes and driving oxidative events.
The gene centric view has driven us down too many dead ends. Cancer cells, even in the same tumour, can have a multitude of different mutations. Keep in mind though that if you examined normal tissue you will also find a multitude of mutations. I have seen pictures of cancer cells with completely disrupted chromosomal arrangements, so much so that it beggars belief how the cell even functions. Only recently some Aus physicists put forward a startlingly hypothesis: cancer arises from an ancient gene code that goes unchecked. Think about it, most single celled organisms will replicate until the food supply runs out, multi-cellular organisms have tightly controlled “stop points” in cell division. An interesting idea but there are lots of those in cancer research.
See and take heed of this end remark(no easy answers):
http://www.science20.com/emergent_fool/blog/cancer%E2%80%99s_inconvenient_truths
John H.
20 Apr 11 at 4:09 pm
“Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are Doctors – to a striking extent – still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.”
Above is the introduction to the following article – “Lies, Damned Lies, and Medical Science.”
It might also explain why everyone has a different theory about what causes what.
Blaise Pascal once said – “People almost always arrive at their beliefs not on the basis of proof but on the basis of what they find attractive.”
Ellen of Tasmania
20 Apr 11 at 4:46 pm
Increasing rates of cancer could partly (or even mostly) be a simple function of not dying of something else first.
It would have to be a factor.
FDB
20 Apr 11 at 7:20 pm
Not dying? WTF? are you bonging again, FDB?
Dude, lay off the reefer.
JC
20 Apr 11 at 7:23 pm
No he’s right. It’s the same as your lung cancer argument.
.
20 Apr 11 at 7:37 pm
If you live long enough, you’ll get cancer is what I think FDB is saying.
Infidel Tiger
20 Apr 11 at 8:13 pm
Oh Thanks guys…
I thought he was bonging on and thought people live forever.
JC
20 Apr 11 at 8:18 pm