Newer guidelines suggest starting medications earlier because patients aren’t compliant with lifestyle changes:
“We recommend starting patients on metformin immediately,” said Dr. David M. Nathan, who directs the diabetes center at Massachusetts General Hospital and is a member of the group that formulated the new guidelines. “Don’t start with lifestyle alone, even for newly diagnosed people. Most end up failing the lifestyle recommendations.”He added: “What classically happened was that the patients would take three months and try to diet. It wouldn’t work. Then they joined a health club. It didn’t work. Then they take another three months and try some more. By the time they were on effective therapy, they had had diabetes for years and years.”
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{ 5 comments }
How arrogantly judgmental of the individual patient. Cookbook medicine and treating patients as cattle; not the doctor I would see.
If a cheap first-line antibiotic had, say, an 80% failure rate in curing an infection then you wouldn’t find a doctor in the world who would advocate completing the full course first, and prescribing something more effective and expensive only after it fails.
This guy isn’t predicting a failure rate for lifestyle changed based upon his own prejudice against the individual patient; this is an outcome which has already been observed scientifically for years. If you want to get all politically correct and feign offense, go ahead, but he has the truth on his side.
But throwing in the towel on right living just seems a pitty. Drugs have external costs (insurer, employer, taxes or whoever does the paying) and have side effects, sometimes debilitating (again, more external costs).
Good clean living according to the biologic needs of our bodies has no external cost, but does require some effort from the patient. There are no side effects and many secondary benefits to be had.
So even if the efficacy sucks like jackiemd suggests for the 80%, why not start by providing the best intervention for the motivated 20%, whom you can only identify after treating all to lifestyle change. The cost of failure, i.e. identifying the 80% is minimal and then drug treatment can be targeted to this group. To drug those who can or will adopt a lifestyle consistent with their body’s needs is irresponsible.
“If you want to get all politically correct and feign offense, go ahead, but he has the truth on his side.”
The truth is that this is the downside of “evidence based medicine” and the antithesis of medicine as an art. Highly patronizing; I would expect better out of Mass. General.
Heya Kevin,
I tend to cave early to meds on top of lifestyle.
Strokes are bad.
–drncc–
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