Thursday, January 19, 2006
Beth Israel has closed its diabetes center, for lack of funds
LOOKING AHEAD by Wally Dobelis
For years this column has brought to your attention the epidemic of fat Americans, the French-fry eating and soft-drink sipping heartbreaking people who inhabit fast-food places between hospital visits, talking about their diabetes and high blood pressure. There are kids who never see a home meal, and adults who are incapable of making one. Help is needed, and the government, NY State, the hospitals and the insurers are failing us.
The facts came most poignantly to this column’s attention while reviewing local takeout facilities in 2004, and walking into restaurants and looking at the clientele. The series of articles did not cover fast-food services, from McDonalds through Starbucks and Au Bon Pain, but seeing was enough. More disturbing were lunchtime sightings in beautiful Columbia County, a hundred miles north, an agricultural area of largely defunct family farms that has lost its place in this mass-production world and survives as a weekenders’ paradise. There the Burger Kings and Wendies have lots of clients who live on 99 cent meals, Cokes and French-fries, and Bob’s $1 weekday breakfasts, with disturbingly many of them in the 300 to 400 lb. weight class, slowly ambling around, a few of them youngish people, leaning on sticks or crutches. The Ponderosa steak house’s eat-all-you-can salad bar drove the restaurant out of business; there were too many big eaters.
Interestingly, the Homeless Shelter Program at Brotherhood Synagogue brings a revelation. Twenty four years ago, when it started, you had to ask the guests at the sandwich and soup dinner how many sugars they would like in their coffee, because often the normally sugared drinks were returned as insufficiently sweet. Three or four spoonfuls were the norm. Now, in recent years, through some good tutoring at the intake center or elsewhere, the sugar use has fallen to nearly normal. Wish that the rural poor would learn this lesson.
Schools seem not to have learned, offering sweet automat food and sugared Snapple drinks for lunch breaks. Kids are naturally drawn to sweets, and bringing them to classes is a popularity enhancer.
Now the NYTimes has undertaken to expose the diabetes/overweight scourge, in four articles, starting 1/9/06. The incidence of this sneakup killer has nearly doubled since 1980, and the cost of treatment, maybe up to $1,600 a year if caught early and treated through medication, diet, exercise and constant watchfulness and preventative means, can shoot up into a $30K stroke, $30K leg amputation or heart attack, $37K final stage kidney disease or $50K stitching up of the stomach. Nearly 21M Americans are diabetic and 41M are pre-diabetic, with blood sugar around the 136 borderline mark, and the US and our own NY state pay little attention. Tuberculosis, with 1000 NY incidences a year, got $27M and a staff of 400, diabetes in NY has three people and $950K in funds. The 2002 nationwide cost of diabetes was $132B, while all cancers together cost $171B.
Maybe it has to do with the fact that poor Americans, Blacks, Hispanics and Asians with a high genetic pre-disposition to diabetes are the main victims. Maybe it is due to the slow non-dramatic movement of the disease, and the cultural difficulties (fat is beautiful in some Asian and Latin contexts, and eating a lot is health-inducing for people who come here from starvation). It definitely has to do with a growing level of inactivity, starting in the 1940’s, when TV kept kids in the living room rather than outside, playing ball, then spread more when the Internet took over, with its quasi-intellectual cachet. The sad fact is that computer use can be associated with building up the intellect, and it mostly does, but often it is frittered in endless computer mail and games masquerading as homework.
One would expect that diabetes prevention and early control programs would flourish. Not so. Doctors in four NYC hospitals, including the Fierman Center of Beth Israel hospital, on 17th Street, set up clinics for education, dieting, exercise and medication of diabetes. Three of them have since closed, including the BI one. They did not fail the patients, they failed to recoup costs, bleeding money, losing $1.1M in ten months.
You might think that in the days of certain specialist doctors earning over $1 M annually, this loss could be carried. Not so. Insurance companies that pay huge sums for operations, nickel-and-dime the preventive programs to death, even though they were run by nutritionists rather than endocrinologists (the US is not training too many in that specialty either, the payback is low and the work hard). The key is the focusing in US medical industry on acute illnesses while neglecting slow-moving chronic ones.
So, what is the solution? The mind boggles, there are so many players; public awareness, education, cooperation and money are the main ingredients. We are bound to see progress in this generation, the exposure is too striking, but not without heavy lifting.
Many thanks to NYTimes. See the blog behind www.dobelis.net for more
For years this column has brought to your attention the epidemic of fat Americans, the French-fry eating and soft-drink sipping heartbreaking people who inhabit fast-food places between hospital visits, talking about their diabetes and high blood pressure. There are kids who never see a home meal, and adults who are incapable of making one. Help is needed, and the government, NY State, the hospitals and the insurers are failing us.
The facts came most poignantly to this column’s attention while reviewing local takeout facilities in 2004, and walking into restaurants and looking at the clientele. The series of articles did not cover fast-food services, from McDonalds through Starbucks and Au Bon Pain, but seeing was enough. More disturbing were lunchtime sightings in beautiful Columbia County, a hundred miles north, an agricultural area of largely defunct family farms that has lost its place in this mass-production world and survives as a weekenders’ paradise. There the Burger Kings and Wendies have lots of clients who live on 99 cent meals, Cokes and French-fries, and Bob’s $1 weekday breakfasts, with disturbingly many of them in the 300 to 400 lb. weight class, slowly ambling around, a few of them youngish people, leaning on sticks or crutches. The Ponderosa steak house’s eat-all-you-can salad bar drove the restaurant out of business; there were too many big eaters.
Interestingly, the Homeless Shelter Program at Brotherhood Synagogue brings a revelation. Twenty four years ago, when it started, you had to ask the guests at the sandwich and soup dinner how many sugars they would like in their coffee, because often the normally sugared drinks were returned as insufficiently sweet. Three or four spoonfuls were the norm. Now, in recent years, through some good tutoring at the intake center or elsewhere, the sugar use has fallen to nearly normal. Wish that the rural poor would learn this lesson.
Schools seem not to have learned, offering sweet automat food and sugared Snapple drinks for lunch breaks. Kids are naturally drawn to sweets, and bringing them to classes is a popularity enhancer.
Now the NYTimes has undertaken to expose the diabetes/overweight scourge, in four articles, starting 1/9/06. The incidence of this sneakup killer has nearly doubled since 1980, and the cost of treatment, maybe up to $1,600 a year if caught early and treated through medication, diet, exercise and constant watchfulness and preventative means, can shoot up into a $30K stroke, $30K leg amputation or heart attack, $37K final stage kidney disease or $50K stitching up of the stomach. Nearly 21M Americans are diabetic and 41M are pre-diabetic, with blood sugar around the 136 borderline mark, and the US and our own NY state pay little attention. Tuberculosis, with 1000 NY incidences a year, got $27M and a staff of 400, diabetes in NY has three people and $950K in funds. The 2002 nationwide cost of diabetes was $132B, while all cancers together cost $171B.
Maybe it has to do with the fact that poor Americans, Blacks, Hispanics and Asians with a high genetic pre-disposition to diabetes are the main victims. Maybe it is due to the slow non-dramatic movement of the disease, and the cultural difficulties (fat is beautiful in some Asian and Latin contexts, and eating a lot is health-inducing for people who come here from starvation). It definitely has to do with a growing level of inactivity, starting in the 1940’s, when TV kept kids in the living room rather than outside, playing ball, then spread more when the Internet took over, with its quasi-intellectual cachet. The sad fact is that computer use can be associated with building up the intellect, and it mostly does, but often it is frittered in endless computer mail and games masquerading as homework.
One would expect that diabetes prevention and early control programs would flourish. Not so. Doctors in four NYC hospitals, including the Fierman Center of Beth Israel hospital, on 17th Street, set up clinics for education, dieting, exercise and medication of diabetes. Three of them have since closed, including the BI one. They did not fail the patients, they failed to recoup costs, bleeding money, losing $1.1M in ten months.
You might think that in the days of certain specialist doctors earning over $1 M annually, this loss could be carried. Not so. Insurance companies that pay huge sums for operations, nickel-and-dime the preventive programs to death, even though they were run by nutritionists rather than endocrinologists (the US is not training too many in that specialty either, the payback is low and the work hard). The key is the focusing in US medical industry on acute illnesses while neglecting slow-moving chronic ones.
So, what is the solution? The mind boggles, there are so many players; public awareness, education, cooperation and money are the main ingredients. We are bound to see progress in this generation, the exposure is too striking, but not without heavy lifting.
Many thanks to NYTimes. See the blog behind www.dobelis.net for more
# posted by Wally Dobelis @ 6:27 PM 
