Wednesday, May 18, 2016

Words Kill

Words Kill

"Sticks and stones may break my bones, but words will never hurt me."  Except they do.   How those word choices result in governmental policies; medical protocol; access to, not only insulin and CGMs, but food and clean water: these determine who lives and who dies.

Words divide Us from Them:  Those Who Deserve What They Get versus Those Who Deserve to Live Well.  Call it what you will: Type 1.  Type 2.  Juvenile diabetes.  Diabetic.  Person with Diabetes.  Maybe Pancreatically Challenged, because some are born with better pancreases than others, however that manifests.  Some people could be tossed into a giant vat of sugar and have to eat their way out and they would be perfectly fine. Sticky but fine. I like the acronym LADA.  A Lada is a Soviet car that is rumored to have less than optimal reliability and performance, just like my pancreas.  But whatever they call us, the result is that some are somehow not as blessed as others. For whatever reason, some can no longer effortlessly maintain a steady blood sugar.

Unfortunately, anyone can join at any time. Wearing a CGM, I can see at any moment whether my blood sugar is within bounds.  For most, ignorance is bliss.  What they don't see doesn't exist. As far as they know, their blood sugar is a perfectly straight line at the perfect number.  Gooba, gahba. They may already be one of us.

If it were just verbal abuse from select idiots, I could shrug it off.  But lives are being put in jeopardy and people are profiting from those decisions.

Diabetes is being marketed as a Lifestyle disease.  "If  people would make only good choices, diabetes would go away." The notion is attractive.  Think of the money saved.

In detective stories the rule is Follow the $$$.  Who profits?

The Weight Loss Industry had revenues of $64 Billion in 2014. Magazines like Fortune and Forbes report that those in the industry are worried about losing market share.  The wine industry didn't do as well as they did  ($37B). Others have already ranted about the huge profits made by insurance and pharmaceuticals.

The IDF has shifted its campaign goal to increasing access to healthy food as a means of lowering the incidence of diabetes.  Most think of this in terms of Preventing Diabetes by Eliminating Junk Food. McDonalds.  Coca-cola.  Government leaders and wealthy individuals can feel righteous and holy. The shift came, however, after the IDF published that they had finally gotten around to looking at a study they commissioned, "A Sub-Saharan African perspective on Diabetes" published October 2009 in Diabetologia (52:8-16), explaining MMDM (malnutrition-modulated diabetes mellitus).  Last year, a study was published in Science Daily about women who were pregnant during the Nazi Occupation.  Metabolic changes were passed down to the second generation. [Columbia University's Mailman School of Public Health. "Increased odds for type 2 diabetes after prenatal exposure to Ukraine famine of 1932-33."]  Thus far, no studies have been done on the results of generations of starvation policies on certain populations in the US.

Ensuring that people have access to sufficient nutrition may eliminate one cause of diabetes.  I fear, however, that instead the programs and rhetoric will be twisted into rationale for denying people food.  "See, rates were lower when Those People were starving."  Why spend money on food programs when you can starve people for their own good?  And why spend money on insulin and all the other paraphernalia, foot exams, education, etc. that the pancreatically challenged need to survive?  Of course, wealthy and powerful potentates won't be asked to skimp on food or do without insulin.

This is the big, ugly picture behind the words.  This is how semantics becomes genocide.  Not just in third world countries, but here at home.  I see it in posts on the DOC.  In horror stories of poor people of any color, white or brown, being denied access to health care, told they don't need test strips and insulin, just less food. In my own misdiagnosis of Type 2.  In the constant admonishments to eat less and join a health club/weight loss program (rather than swim and dance) matched by cut-backs or cancellations of my prescriptions.  If, as I've been told for 12 years, I am doing better than most of your other patients, why can't I keep getting the stuff that enables me to do so well?  By saving the insurance company a few bucks, will I be any healthier?  Or will I be an even bigger cost-savings if I'm dead and you can blame me for my death?  Maybe I have outlived my usefulness. Maybe if my life were as valued as theirs, they wouldn't mind the expense.

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