Deluding Ourselves on Medical 'Cures'
CHICAGO -- I'm glad I'm not the only one whose blood pressure rises every time a quick fix to a complex, multilayered medical conundrum spreads through the media despite researchers' warnings that results from small, short studies can't be generalized.
"To promote gastric bypass surgery as a quick fix for diabetes is unconscionable," said Dr. Jane L. Delgado, president and CEO of the National Alliance for Hispanic Health, in reaction to the news about two studies published in the New England Journal of Medicine that spurred headlines implying that the risky surgery could cure diabetes. "The outsized media attention to these limited studies gives false hope to diabetics and could be dangerous to health."
The rush to celebrate a cure du jour to medicine's most intractable problems is a result of people's deep desire for science to come up with some solution that will enable them to engage in pleasurable, sometimes destructive behaviors, without fear of unhappy consequences.
In this case we're talking about Type 2 diabetes, my personal nemesis as I battle a strong familial affinity to the disease, and one of the fastest growing epidemics in human history. That it's related to out-of-control weight gain relegates policy discussions about dealing with the pandemic to the uneasy area where moral and medical arguments collide.
The latest buzz is that patients in two new studies who had surgery in which the stomach is stapled and the small intestine rerouted were found to have a complete remission of their diabetes, or to be more likely to need less medicine than patients who were in charge of maintaining a rigorous disease-management regimen of drugs, strict diet and exercise. Some surgical patients also experienced lower blood pressure and cholesterol.
The problem is that -- in stark contrast to eating fewer calories and exercising daily -- these surgeries carry tremendous risks, and their long-term effectiveness is also contingent on limiting diet and exercising regularly.Â
"People are excited about this 'cure' because people want a quick and easy answer even when the problem is so complex," Delgado told me. She said the explosive growth in weight-loss surgeries "reminds me in many ways of the primitive positions we used to take with women and hysterectomies. The standard of care was that you took everything out and then scientists realized that, guess what, even when you're not making babies, ovaries are producing hormones that are good for you. Today there is a less extreme standard of care. Â
"The way people are heralding this is ahead of where the research is but behind where the science is going. We need to do the five-year studies -- what if it happens that everyone has gained the weight back and meanwhile people are still undergoing very invasive surgery with difficult recoveries?"
We're not completely in the dark on that, either. A Belgian study recently published in the Archives of Surgery reported that more than a decade after having stomach-banding surgery, nearly half of the patients needed to have the bands removed. More than half of them had to have additional surgery, including a gastric bypass, and most lost less than half their weight goal. "Relatively poor long-term outcomes," was the conclusion.
Obesity, the leading driver of the explosion of Type 2 diabetes and numerous other diseases, is caused by a lack of knowledge about balanced nutrition, poor day-to-day food choices, and insufficient exercise. It has flourished in the uncomfortable intersection of personal liberties, persistent poverty and under-education, and the ongoing debate about whether personal responsibility is invalidated by the limits of individual willpower.
Why are we looking at surgery when countless studies have shown that nutrition is not adequately taught or modeled in schools, where children are less likely to have opportunities to exercise during the day? And why arent more doctors trained to counsel patients about their dietary and exercise needs? Indeed, studies show they're less likely to bring it up if they are more overweight than their patients or facing down a parent who won't stand to be told their child is obese.
Meanwhile, those not yet fully saddled with the medical complications of obesity feast on pop science stories that either feed our desires to eat what we want -- what, you hadn't heard that chocolate might help keep people slim? -- or lull us into believing that the simple solution lies under the knife.
Esther Cepeda's email address is estherjcepeda(at)washpost.com.Copyright 2012 Washington Post Writers Group