TCS Daily


The Diabetes Legend

By Arnold Kling - January 25, 2006 12:00 AM

"Insurers, for example, will often refuse to pay $150 for a diabetic to see a podiatrist, who can help prevent foot ailments associated with the disease. Nearly all of them, though, cover amputations, which typically cost more than $30,000."
-- Ian Urbina, The New York Times, January 11, 2006

In a previous essay, I pointed out the pervasiveness of folk Marxism -- the belief that political economy can be explained in terms of classes of oppressors and oppressed. Along those lines, Ian Urbina's article turns the disease of diabetes into a folk Marxist legend. The oppressor health care suppliers mistreat the disease, because they earn more profits from expensive operations than preventive medicine. The oppressor health insurance industry is on the side of the health care suppliers. The only friend of the oppressed diabetes patient is the liberal politician.

For me, it is a bit difficult to credit the notion that insurance companies induce people to choose foot amputations over preventive visits to podiatrists. Even if the podiatrist visit is not covered by insurance, it would seem that an individual diabetic would have a fairly strong incentive to go to the podiatrist, anyway. But apparently the folk Marxist appeal of putting the blame on the insurance industry overcomes any such skepticism.

Urbina focuses on the Beth Israel diabetes treatment center that closed because of lack of funding. The treatment philosophy of the center comes across as sound. Urbina tells some inspiring anecdotes. However, he offers no data on the overall performance of the treatment center. Did it achieve success with fifty percent of its patients? Ten percent? One percent?

I would trust liberals a lot more if they would ask questions about effectiveness. Instead, Urbina, like many people who trade in folk Marxist narratives, focuses on establishing the superior motives of the Beth Israel diabetes treatment center and the misguided motives of health insurance companies and others. I do not know any more than Ian Urbina does about the effectiveness of Beth Israel's treatment center. But apparently I care more.

What's Different About Diabetes?

Diabetes differs in many important respects from, say, a broken arm. First, the adverse impact on health from diabetes is long-term. Second, there are many potential complications. Both of these characteristics admittedly pose challenges for conventional health insurance.

However, the biggest challenge for everyone involved in diabetes treatment is that patient skill is a major factor in treating the disease. Urbina's article brings this out. Diet and weight control are important. The appropriate level of medication depends on blood sugar levels, which must be tested frequently. A patient who is knowledgeable, well-organized, and possesses strong willpower can manage the disease far more effectively than a patient lacking those qualities. Much of the focus of the Beth Israel treatment center appeared to be on raising the skill levels of diabetics.

The challenge in providing insurance to a diabetic population is taking patient skill levels into account. In theory, a health insurance company could offer skill-based health insurance premiums. Diabetics with the highest skill levels would pay low premiums. Diabetics with the lowest skill levels would pay high premiums. I do not know whether it is practical for health insurers to differentiate this way, or whether regulators would allow it.

It seems that we want diabetics to increase their skill levels. Skill-based insurance premiums would get their attention. However, there are no doubt other obstacles.

Poverty is one obvious factor in the low skill level of some diabetics. One would hope that Medicaid would work to alleviate this. However, Urbina's article points out that the Beth Israel Center lost money on Medicaid patients because of Medicaid reimbursement rules. To me, this suggests either that the government was not convinced of the value of Beth Israel's treatment system or that single-payer health insurance is not the panacea for disease management that liberals take it to be.

Lessons for Liberals

The legend of diabetes is that diabetics are an oppressed class. The oppressor food industry causes diabetes in the first place. Oppressor health care suppliers profit more from acute care than from chronic care. Nationalized health care will end the oppression of diabetics. But evil corporations and unfeeling libertarians favor continued oppression.

Before we base policy on legends, I would ask liberals to pause and consider what we know and what we do not know about diabetes. We know that it can be a devastating disease. We know that the key to better management of the disease is patient skill level. We do not know which programs are proven to be successful at raising patient skill levels. We do not know that government is better than the private sector at encouraging prevention and disease management.

There may be a good case for greater government support for people with diabetes. However, it would be better to see that case made using data, not folk tales.

Arnold Kling is author of Learning Economics.
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42 Comments

Mistatement to the point of mendacity.
The characterization of the Times story by Urbina is utterly mistaken.

"The oppressor health care suppliers mistreat the disease, because they earn more profits from expensive operations than preventive medicine. The oppressor health insurance industry is on the side of the health care suppliers. The only friend of the oppressed diabetes patient is the liberal politician."

The Times story in no way says this. It does point out that the economics of health care reimbursement is now structured in such a way that providers make better profits on drastic treatments such as operations than they do on preventive care -- they in fact lose money on preventive care.

This is in no way couched in terms of oppressors and oppressed. It's just a simple, accurate statement of the way the system as now structured works. It's quite clear that structuring the system differently would be better for society (which winds up picking up the tab eventually in all kinds of ways) as well as for diabetics. The idea of oppressors doesn't even enter the equation.

Going further, the dimensions of Kling's phony dichotomies become clear. While the Times doesn't point fingers about guilty parties, in fact in some cases people _do_ exploit and do things that create victims. To dismiss out of hand any and all accounts or criticism of such behavior is industrial strength excuse making and denial. To talk about 'individual responsibility' as resolving any and all such cases without government is ridiculous: among other things, part of journalism is in fact assigning responsibility to individuals. But Arnold doesn't want to know, and doesn't want to hear.

Repeating the folk tale
Nothing in the Times story actually proves that providers lose money with effective preventive care. You are just repeating the folk tale without providing any evidence for it.

If the Times were not trying to turn this into a folk Marxist story, then they could tell the tale without making health care providers the issue at all. What is really going on here is that consumers are failing to obtain preventive care. If you want to say that the incentives consumers face are skewed away from preventive care, that might be valid, although still somewhat speculative. But telling the story in terms of consumer incentives would empty the tale of its folk Marxist drama.

Flawed analysis
This is an unfortunate analysis by someone who clearly has no idea how reimbursement to physicians was established. The manner of reimbursement is historical. Years ago when so-called cognitive services offered little in the way of care for a patient, these group of services (i.e., those that did not involve procedures) were not reimbursed well. Although there has been some change in that regard over time, it has not chnaged commensurate with the ability of cognitive services to favorably affect patient care. For example, we now have the medications that make major inroads to prevent future problems and treat illness in earlier stages to avoid catastrophic but necessary proceedural decisions like am****tions.

The writer also misunderstands human behavior. Typically, we respond to medical situations that involve crisis much more aggressively than those matters that involve attention to prevention. So it is not a matter of simply having a more skilled patient population (don't get me wrong, that is important too), but rather having incentives in place that are aligned to encourage patients in the direction of prevention. To not reimburse prevention services adequately is a disincentive - that is what needs to be changed. Many of my patients simply can't afford the cost here and don't come in for care and then show up for the am****tion.

Marxist/liberal formulation? I don't think so.

Steve Wright, MD

Health Insurance Companies
Health insurance companies vary widely, but the one I work for would have covered the initial consult, the prevention, and if necessary the am****tion. The arguments about who makes money in this situation depend a lot on the type of plan.

For a typical HMO, this would break down something like:

Initial consult with Primary care physician
Referral to podiatrist
Hopefully corrective action
Possible surgery scheduled for am****tion

At each step, the physicians are making money. It doesn't effect the bottom line of your primary physician or even your endocrinologist whether you treat your foot because you will undoubtedly be seeing a different specialist.

The only effect of not taking care of this in the early stages is that the insurance company pays out a *lot* more. How does it make sense that they would encourage this? It doesn't. Few plans steer people away from this type of prevention. If you have one of these plans, consider a different choice of plan or employer.

the idea that this was "folk Marxism" is the folk tale
The Times documented how much the procedures cost, and what the reimbursement was. The providers lost money on the reimbursement for preventive ones; made money on surgery.

And the providers weren't made an issue, or the oppressors: the Times wasn't saying they were doing anything wrong, or profiteering. It was simply pointing out that the economics of the system produced a perverse and undesireable effect: more money was being spent on a line of care that was both worse for patients (am****tions) and worse for taxpayers.

The entire power of the story was in fact the way it AVOIDED finding scapegoats and villains. It emphasized the way that patients were digging their own graves by unwise choices. But it also presented the underlying economics.

> What is really going on here is that consumers are failing to obtain preventive care.

Yes, but you're missing a critical element in the "consumer" loop. Government - Medicaid - is the consumer here as well as individual poor people. The program would be both more effective and cheaper if diabetics received preventive care. The problem is the econonics have been set up so providers have a negative incentive for doing so.

"But telling the story in terms of consumer incentives would empty the tale of its folk Marxist drama."

First, again, you're competely mischaracterizing the piece. But second, what you're criticizing it for is not telling your own private folk-Van-der-Mies libertarian story in which government action to do anythig is always wrong.

effectiveness?
I do not doubt that the providers lost money on preventive treatment. The question is whether their treatment was effective. That was never documented.

It is not a folk tale to say that consumers can choose preventive health care. If I were doing the reporting on this piece, the question that would be uppermost in my mind is why they don't choose preventive health care.

Inaccurate characterization
Perhaps Mr. Kling read a different story than the one published in the Times.

"Instead, Urbina, like many people who trade in folk Marxist narratives, focuses on establishing the superior motives of the Beth Israel diabetes treatment center and the misguided motives of health insurance companies and others."

This seems almost perverse. Yes, the Beth Israel center tried to help diabetics manage their illness. Surely readers can make up their own minds about the desireability of this end without being lectured, and the article didn't lecture. As to the 'motives" of insurers, all that was brought up was the way reimbursements were calculated. Nobody was twirling a moustache. But for Kling noting this as a factor in decision making is "folk Marxism."

And government wrong if it does, wrong if it doesn't
And this:

"One would hope that Medicaid would work to alleviate this. However, Urbina's article points out that the Beth Israel Center lost money on Medicaid patients because of Medicaid reimbursement rules. To me, this suggests either that the government was not convinced of the value of Beth Israel's treatment system or that single-payer health insurance is not the panacea for disease management that liberals take it to be. "

Brilliant. One major point of the article was that the structure of Medicaid was counterproductive in the case of diabetes, indicating that a change might be in order. But the dichotomy posed by Kling is heads-I-win, tails-you-lose.

Effective everywhere else
If you ask any doctor on the planet whether preventive health care for diabetes is effective, I don't think you'll get a single negative answer. It's like asking if penicillin works. If patients do it, they benefit.

The trick is motivating them to do it, as the story exhaustively documents.

As far as why they didn't choose preventive health care- that's covered and covered and covered in the story: cultural reasons, personal reasons, money reasons. The starting point in the story is the question of why diabetes is becoming epidemic, particularly in poorer and minority areas.

Your "folk-Marxism" blinders insists on seizing on this fact, the demographics of the epidemic, and turning it into an oppressed v. oppressors narrative, when the author (and this was what I thought was the brilliant thing about the story) just focuses on cuases and effects, not oppressors and effects. I suggest you re-read the story.

Diabetes myths
There are a number of non sequiters here. HMOs tend to ignore preventive medicine, in spite of advertising to the contrary, because members change carriers and the payoff may benefit another HMO. My son developed type I diabetes at the age of 27. His HMO gave him a video as the total new diabetic education they offered. I sent him to a dietitian and other consultants at my expense. This is basic in the care of a new diabetic, yet they ignored it. The doctors get no financial benefit from such poor practices. It is purely a fiscal decision by non-professionals. Needless to say, he is no longer an HMO member. Not every new diabetic has that option.

University specialty clinics, like the one being discussed, tend to be inefficient and expensive. The administrators also have much greater power than the physicians. The result is often the abandonment of promising programs because they lose money. Blaming Medicaid or insurance may feel good but the problems usually are internal.

The silent issue with diabetes mythology is the effect of immigration. The childhood obesity issue, for example, ignores the question of the increase in Hispanic children in schools and what effect this has. TV and lack of exercise are significant but there is an elephant in the room that everyone studiously ignores. What is the demographic data on obese children ?

Marxism is a crutch for those who don't understand economics and human behavior.

Diabetes Facts
The Diabetes Diet : Dr. Bernstein's Low-Carbohydrate Solution
Both forms of diabetes are the result of lack of insulin production.
Insulin spikes with glucose levels and tries to force the cells to take the sugar or convert to fat.
Seems pretty simple, limit glucose spiking foods.
The medical establishment has raked Atkins over the coals yet he was one of many on the right track.
Check out Dr. Berstein's book. He is a type I and uses low carb foods to control his diabetes.
Another good book is the Metabolic Typing Diet which discusses indiginous diets. Hispanics immigrating to an American diet upset their metabolism leading to type II diabetes.
Don't hear much in medical community about this.
Stop and look at how much sugar (high fructose corn syrup, sucrose, fructose, white flour, etc is in all procssessed American foods.)

metaphor for life in general
"A patient who is knowledgeable, well-organized, and possesses strong willpower can manage the disease far more effectively than a patient lacking those qualities."

The same qualities that generally promote success in all matters of life.

Very Much Accurate
First, let me get some things clear:
1. I am not a liberal --- I beleive in Winston Churchill's statement that if you are not a iberal when you are young you have no heart; if you are not a conservative when you are older, you have no brain.
2. I have been in the healthcare field for over 32 years.
3. I have written over 160 publications in the healthcare field over the past 23 years, most of them books and several on diabetes.
4. I have studied diabetes care internationally.
5. I am a Type II diabetic.
6. I was interviewed for Ian Urbina's article and was displeased with it.

Second, that being said:
1. Insurance companies do have a greater incentive NOT to cover preventive medicine. As I told Mr Urbina and he agreed, insurance companies look at paying for preventive care as benefitting other insurance companies, but not their own. Talk to any health insurance company and you will get the same answer. But that is a specious argument. Even if individuals change health insurance on the average of every 2.5 years (which they do --- largely because of job change and because insurance companies raise rates on individual insurance horribly after the first two years), the whole system is a giant merry-go-round --- people changing horses in the same system. As a result, paying for preventive care helps all companies. But no company wants to be first because they fear the others might not and they will be stuck with an on-rush of clients looking for preventive care benefits.
2. The thought that there is collusion between the insurance companies and the healthcare products companies is simply absurd.
3. I don't know what the effectiveness of the diabetes clinic at Beth Israel was either --- and it would be nice to know. But Mr Urbina could have found out the effectiveness of many other diabetes clinics around the country and given a range of effectiveness and an average. Given the location of Beth Israel, I can understand why they might have had problems both with performance and costs, but a focus on the one clinic is simply wrong.
4. Medicare and Medicaid are screwed up. But a national healthcare system yould be worse --- as GH Bush said, with the efficiency of the Post office and the sensitivity of the IRS. No socialized healthcare system in Europe is effective at the providing the highly effective healthcare that we have in the USA. I can say that from experience. 5. While a recently-established diabetes clinic system in Italy (where Type II diabetes rates have been the second highest among the seven major healthcare systems of the world and they have a socialized healthcare system) appears effective, it exists in a socialized system only because the people demanded it and because Italy's politicans are a lot more sensitive to their populace than Congress. Among the seven major world healthcare systems, Germany, (with extremely high Type II diabetes rates and a socialized healthcare system) strictly limits diabetes monitoring and treatment payments --- to the point where docs have to pay from their own pockets if they go over those limits. (So much for Bill Clinton's using Germany as a model healthcare system!!!) All of these countries have high tax rates to pay for these systems and none has the robust economy to do so because their tax rates make the costs of labor high, their products less competitive on the world market, and their entrepreneurism limited --- killing their economies.

Third, Mr Kling is right saying that a skills-based system of health insurance rates would be a good means of encouraging preventive care insurance. However, I would have to change this to a skills-and-compliance-based system. There are many diabetes education programs --- they even have a certification for diabetes educators --- but unless the patient follows through on these skills that are taught them, there's no reason to reward them. Compliance is also easier to measure.

Fourth, the Marxist approach to healthcare is irrational, unreasonable and downright stupid. Hillary Clinton and her healthcare program, and her continung beliefs in such an idiotic system, would be the ruin of American healthcare.

Mr Kling writes: "The legend of diabetes is that diabetics are an oppressed class. The oppressor food industry causes diabetes in the first place. Oppressor health care suppliers profit more from acute care than from chronic care. Nationalized health care will end the oppression of diabetics. But evil corporations and unfeeling libertarians favor continued oppression."

HE IS RIGHT ON! None of these myths is true.

While I may disagree with a couple of Mr Kling's details, he is still RIGHT ON in his conclusions --- especially that we have to get rid of the belief in these folk myths about diabetes and other healthcare and get back to solid data --- data that I have both seen and accumulated. As a recognized expert in the healthcare field, I say --- RIGHT ON, MR KLING!!

Folked up
The attack is on a straw man:

"The legend of diabetes is that diabetics are an oppressed class. The oppressor food industry causes diabetes in the first place. Oppressor health care suppliers profit more from acute care than from chronic care.

Adding the word "oppressor" in front of "food industry" and "health care suppliers" is something that Urbina does not do. What he does do is demonstrate that both are private business that have incentives, as the market and regulation are currently structure to do things with negative public health impacts. The oppressor label brings up the image of villains in offices twisting moustaches cackling about fulfilling their quota of diabetes am****tions. The truth, as Urbina illustrates, is infinitely more complex,

" Evil corporations and unfeeling libertarians favor continued oppression."

And this is more of the same. Corporations are in business to make money. The practices described make money and are legal. Adding the word "evil" simply complicates a solution to a problem that -- and this is another major strength of the story -- costs all of us, the whole society money and wastes resources, human and medical.

"Nationalized health care will end the oppression of diabetics."

Again: this is pure rhetoric. Urbina doesn't call for 'nationalized health care" -- that's totally outside the ambit of his story. But this whole song and dance has the bottom line of calling anyone concerned about a health epidemic a "folk Marxist," and the same can be said about concern about any public problem.

If Kling or Dr. X above has specific problems with the story, or an alternative way to bring down the incidence of diabetes, they should bring it forward. But this is just folk denial.

low carb myths
Boy, this is a treasure trove of myths !

"The Diabetes Diet : Dr. Bernstein's Low-Carbohydrate Solution"

Frederick Allen published a low carb (actually zero carb) diet in 1913, before the discovery of insulin. It did keep type I patients alive although at a terrible cost. There is a great story in the NY Times magazine some years ago about the daughter of Charles Evans Hughes, Chief Justice and presidential candidate. She developed diabetes and was kept alive by Allen's diet until the discovery of insulin. She then went on to live to the age of 88. When she was begun on insulin she weighed 44 pounds at age 19.

A low carb diet will NOT successfully treat diabetes type I.

"Both forms of diabetes are the result of lack of insulin production.
Insulin spikes with glucose levels and tries to force the cells to take the sugar or convert to fat."

Type II diabetes is now known to be a combination of high insulin production and a genetic disposition to exhaustion of the beta cells. The relationship of obesity is the high demand for insulin, especially in central (trunk) obesity that is also implicated in the "metabolic syndrome." Diet will prevent the development of type II if obesity is avoided.

"Seems pretty simple, limit glucose spiking foods."

The most recent theory was "hypoglycemia" and millions have been spent on quack remedies of this type. The problem is not spikes but steady high levels of insulin.

"The medical establishment has raked Atkins over the coals yet he was one of many on the right track."

Atkins had some good points and has been neglected by research people who bought into the low fat thing that is just as much a fad as low carb.

"Check out Dr. Berstein's book. He is a type I and uses low carb foods to control his diabetes."

I would doubt this very much. Sounds like 10,000 other diet books that allege success in treating everything from cancer to hives.

"Another good book is the Metabolic Typing Diet which discusses indiginous diets. Hispanics immigrating to an American diet upset their metabolism leading to type II diabetes."

This is also nonsense. Hispanics brought their diets with them. Japanese have suffered by adopting a different diet. That is NOT true of Hispanics.

"Don't hear much in medical community about this."

With good reason.

"Stop and look at how much sugar (high fructose corn syrup, sucrose, fructose, white flour, etc is in all procssessed American foods.)"

Another myth. Fructose does not require insulin to enter the cell. The misinformation on diet is one aspect of the poor knowledge of biology in the graduates opf public schools. They know about Native American culture but not how cells work.

Gost Lost
I did not read the Urbina piece, but from the snippets, it sounds like he should not have wasted his time writing the article, unless it was geared for the health care industry and insurance companies.
Ultimately the responsibility for health care resides in the individual.
From the diabetic's POV, does it matter how much profit is made by the surgeon or the podiatrist?
Only if the diabetic is paying for the cost himself. (Which he ultimately will, with his life, if he does not take care of himself.)

Didn't read the Urbina story, but ready to comment on it?
Thank you for your honesty, but why not invest a little of your time before wasting ours?

Indigenous Diets
Ever wonder why the Indians of the SW have such high rates (>50%)of diabetes?

Also, how did our ancestors live without wheat, corn, honey and sugar?

An African tribe appears to live quite well eating milk and cows blood. Not much to spike insulin production there.

"Americans' consumption of fructose, as a combination of sucrose and high-fructose corn syrup, has increased by 26 percent from 1970 to 1997. The intake of dietary fructose has increased markedly as a result of the steady increase of added sugars to the American diet.

In the past, fructose was considered to be beneficial to diabetes mellitus and insulin resistance because ingesting it results in smaller postprandial glycemic and insulin excursions than do glucose and complex carbohydrates. However, other hormonal factors suggest that fructose actually promotes disease more than glucose. Also, fructose, but not glucose, is metabolized to fat in your liver.

Researchers conclude that added fructose (in the forms of sucrose and high-fructose corn syrup) does not appear to be the optimal choice as a source of carbohydrate in the diet.

Small amounts of added fructose are probably benign and may even have some favorable metabolic effects. However, on the basis of the available data regarding the endocrine and metabolic effects of consuming large quantities of fructose, and the potential to exacerbate components of insulin resistance syndrome, it is preferable to primarily consume dietary carbohydrates in the form of glucose (free glucose and starch).

This is particularly important for those with existing high cholesterol levels or insulin resistance who could be more susceptible to the negative metabolic effects of fructose.

American Journal of Clinical Nutrition, November 2002 Vol. 76, No. 5, 911-922 (Free Full Text Reference)

Why not?
My opinion is just as valid as anyone else's.
When does knowledge of the facts matter to anyone in the media today?
Dan Rather and the NY Times don't seem to think its important to check facts, just make sure the propaganda gets printed.

Cogent!
Your opinon is valid as your opinon.

the question is why anyone should listen to you discussing something you haven't read, but are sure is wrong. How about this: I've never met you and don't know you but I'm sure you're a serial killer. And that's my opinon and it's just as valid as anyone else's, and I'm going to keep repeating it no matter what evidence is brought forward.

Are those your rules? If not, why don't you read the story?

diet continued
"Ever wonder why the Indians of the SW have such high rates (>50%)of diabetes?"

Genetics. Also those groups eat a diet high in carbs because of the indigenous food sources.

"Also, how did our ancestors live without wheat, corn, honey and sugar?"

Wheat goes back to 25,000 BC in Mesopotamia when the end of the ice age led to large fields of grasses that became our cereal grains. Fascinating story that I cover partially in Chapter 1 of my book.

Corn, by which I assume you mean maize, is native to the Americas and was eaten by the Aztecs.

Honey's use as food is ancient and the story is lost in history.

Sugar (you probably mean sucrose) was first cultivated in the 1700s. Fructose has been eaten as long as fruit has been eaten, probably a million years.

What was your point ?

"An African tribe appears to live quite well eating milk and cows blood. Not much to spike insulin production there."

So ? We are omnivorous and the high carb, high sugar diet we eat is a recent development. Just as we are programmed to eat high fat food because fat was rare in pre-historic culture.

I don't understand the point. Keeping at ideal weight with whatever diet you choose will avoid most type II diabetes.

I decided to read the story
At the end, the whole thing could be summarized by this quote from one initial success story:

" "I needed reminding," she said.

With the center gone, Ms. Hammond said she has had to try to muddle through. She goes to the podiatrist once a year, but she said she could not remember the last time she visited an eye doctor. She has gained about 40 pounds.

Some days she wakes up and her blood sugar is high. Other mornings she doesn't bother to check, she said.

"I couldn't get to where I was before," she said.

Most people think of medicine as "broken arm - set it" "appendicitis - cut it out" they've seen too many medical shows where the cure is almost instantaneous.

Too few deal with chronic problems. (I do, as an asthmatic from childhood.) Yea, she initially did a great job but day after day, year after year, "I gotta do this for the rest of my life???"

Our society, medicine, pharmacuticals, all don't do well with chronic disease, but Uncle Sam does the worst.

It works for me
There are over 6,000,000,000 genetic combinations of humans and each person's metabolism is not identical.
I followed recomendations from Drs. Eades and others and lost significant weight and improved my cholestrol numbers.
You are right about genetics. I don't believe humans have evolved yet to eat Doritos and Twinkies or Lucky Charms and Wonder bread and Coke in great quantities.
Therefore what is healthy for one may not be healthy for others.
To make sweeping statements against Atkins or Berstein is irresponsible, or in your case, so YOU can sell a book.

Why not?
You won't believe evidence regarding Love Canal so believe what you want.

Type I - Juvenile Diabetes
My mother had juvenile diabetes, although she was about 30 years old when she show her first symptoms. Type I diabetics is not caused by obesity or diet -- it's genetic.

No Subject
First, I think Fortunato should read Kling's article again. He misunderstands Kling and his use of words to point out the hypocrisy and bias in Urbina's article. (BTW: What the hell are am****tions? AM****TIONS? Why not just call them "the A-word?")

Second, he doesn't get the jist of Urbina's article. I was interviewed for it and I know where Urbina is coming from --- I saw his slant in the interviews. Kling picked it up very well.

Why Uncle Sam?
I mean, government gets stuck with all the hardest cases. That's inherent in the situation. the market takes care of people who can pay well. Government is the last resort. The point the story makes is quite simple: we can pay a little now, or pay a lot more later. Understandably as individuals, we choose the former. But as a society and governent, the choice makes no sense -- and just slagging Uncle Sam doesn't help at all.

Sure. Love Canal
That's the issue here?
Ok, you posted a history that pointed out that Hooker, after dumping chemicals into the canal for years, sold it for $1 to a governent swearing it was safe & clean - but carefully arranging the deal to avoid all further responsibility. This was before it was appreciated just how dangerous toxic dumps could be. So officials went ahead and built housing on the lot (I mean, what did Hooker think would be done), which developed problems. Years of suits, countersuits and investigations followed, and Hooker wound up with a huge bill. You may think this is unjust. Courts didn't. the case wound up creating a turnaround in the handling of toxic wastes, with government collecting money (superfund) from chemical producers, and using it to clean up old sites. You may think this is an abuse of government

What you were saying was that government caused the Love Canal case. It certainly had a role, well-documented, but "caused" -- no way. And this isn't to totally blame Hooker either.

Now why don't you read the folking diabetes story?

Sources
Hooker legally dumped chemicals into the canal.

Hooker legally sold the property to a government who then, despite warnings from contractors and others, built schools and houses.

Why should Hooker have any financial liability?

Because the governments ultimately screwed up and they needed a bad guy. So what will happen to any closed military base? It will stay government property because no business in its right mind would trust any government.

I can't access the article on the NY Times site via the link on TCS and I won't register with NYT beacuse I don't want to give them any ad revenue.
I don't trust anything posted by the NY Times anyway.

Take it to a debate on Hooker chemical
Look, we've been throgh this. You've stated your opinion.

And if you don't think Hooker now Occidenal, has any liability phone the the Justice Department and tell them to return the $129 million recovered in a lawsuit, For some reason, courts don't share your view that Hooker was completely innocent and it was all a big misudernstanding.

>I can't access the article on the NY Times site via the link on TCS and I won't register with NYT beacuse I don't want to give them any ad revenue.

the kindly stop talking about stories you won't read. You're wasting our time.

Don't waste your time
Don't waste your time reading this. I did not read the original story in the NY Times.
Therefore, I cannot comment upon anything related to this story.

BTW, the point to be made with Love Canal is that you refuse to believe investigative reports with documentation that challenge your paradigm.
So why should I waste my time reading NY Times and why do you waste your time reading TCS?

No Subject

Words but no backup
Excuse me but I read Kling's article rather carefully.

You say Urbina's article shows hypocrisy and bias -- but how? Where? What errors did Urbina make? Hypocritical how??

Note that in Kling's account, the story isn't quoted; it's just characterized, and not characterized either extensively or accurately or at length. Instead, Kling says what he says Urbina story does, and then goes sailing off on his "folk Marxist" hobby horse.

Ok, you were interviewed. How did Urbina show bias? You say, he only focused on one clinic. Do you know the clinic as unrepresentative? the times has an ombudsman: have you sent in your criticism?

moving right along
If I can avoid the garrulous F, (one has to admire the quantity of his comments, if not the quality), and return to the subject, I'd like to submit some general comments. I agree, Juvenile D is more likely to be genetically influenced than type II. However, one must consider 'life style' affects, even cultural-life style effects.

Our bodies are designed for paleolithic conditions, i.e. hunter-gathering. Our ancestors evolved under conditions that required daily intense physical activity such as searching out and chasing down our dinner, or running fast for long distances across the savannahs to keep from being dinner. Diets consisted of protein, fat and small amounts of carbohydrates contained in primitive roots, fruits, seeds, (that were nothing like the huge starchy and sugary items we see in the produce department today,) along with copious quantities of feathers, hair and grit.

Then came agriculture, which permitted people to reside in one spot by tending crops, which were able to be bred to contain large quantities of starch and sugar. Populations exploded. Then came commerce in flour, then sugar, cheap food, but it is like trying run a diesel engine on gasoline. It might work after a fashion, but creates lots of health problems, like diabetes, obesity, or rotting teeth. Now that we can afford it, we should try to get back to a version of the paleolithic diet for our health's sake.

One way to accomplish this is; now that we know better what we're doing to ourselves; is to wean infants, before they know any better, on diets devoid of sugar with little
flour or starch. They learn to enjoy, and are imprinted by, healthy foods, that benefit them for a lifetime. There are essential fats, essential protiens, but no essential carbs.

Um, sure
What do these wise comments have to do with the epidemic of diabetes reported in the New York Times?

we have an epidemic in 10-50 year olds in poor neighborhoods. Don says the answer is something individual parents should do to 1-2 year olds. This really doesn't really seem to address the problem.

marxist dielectic
eric is so far gone to the marxist folklore, that he is no longer even able to imagine that there is any other way of thinking.

eric's perspective
When it servers eric's purpose he is adept at reading between the lines, often finding things that no other thinking adult was able to find.

At other times, when it's in his interest eric will loudly proclaim that unless the author spells it out, exactly and with impecable spelling, then he didn't say it.

Type 1 vs. Type 2
Type 1 Diabetes (Juvenile Diabetes)

The immune system destroys healthy beta cells in the pancreas, preventing the body from making insulin. Type 1 does appear to need an environmental trigger, like drinking cows' milk or having a viral infection — particularly coxsackie B, rubella, and mumps.

There is very little that can be done to prevent the disease and the only remedy is taking daily injections of insulin and watching blood sugar levels.

Type II Diabetes (Onset Diabetes)
Healthy cells develop an "insulin resistance" to the body's naturally produced. Changes in diet and weight (as small as a 10-15lb loss) can restore insulin sensitivity.

Many believe that lifestyle (lack of exercise, poor diet, etc.) is the greatest contributor and that stringent weight control in persons with a genetic predisposition can effectively prevent the disease.

treating the symptoms and/or the disease
Very good points, R. Diets and cultural attitudes which eliminate or minimize unnecessary carbohydrates (which is all,or nearly all, of them) will also eliminate or minimize the strain on carbohydrate metabolism and insulin production, which constitute the disease.

eric who?

eric who?
"impecable' spelling

Availability of preventive care
As the father of a child with Type I diabetes I can testify that despite being extremely educated and motivated I constantly have to fight for the best preventive care for my daughter. While you would think that the health care system would have an active desier to pay for care today to prevent greater costs tomorrow that is not what I see happening.
It's possible it would be better reporting to give more concrete examples in the NY Times piece I agreed with everything it said and was deeply disturbed by the mud slinging at it.

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