3 ms·

Historical examples (polio and TB) that fit your #2 criteria don't seem to have the conflicts that you mention - because the organizations can change focus. Dis

by dalke 12y ago

Historical examples (polio and TB) that fit your #2 criteria don't seem to have the conflicts that you mention - because the organizations can change focus. Disease research isn't predictable enough to be able to make financial or organizational planning like you propose. Hence, I don't think your worry #2 is realistic. Here's my reasoning. The March of Dimes started in 1938 as the National Foundation for Infantile Paralysis. They started the serious fundraising and research projects for polio, and provided about $233 million on patient care over 20 years, as well as funding research into a cure. They recruited Salk to work on it, which lead to the successful polio vaccine. The National Foundation for Infantile Paralysis therefore no longer had a reason to exist. Quoting from http://en.wikipedia.org/wiki/March_of_Dimes#Criticism http://en.wikipedia.org/wiki/March_of_Dimes#Criticism : > In his book Essentials of Sociology: A Down-to-Earth Approach, sociologist Professor James M. Henslin describes March of Dimes as a bureaucracy that has taken on a life of its own through a classic example of a process called goal displacement. Faced with redundancy after Jonas Salk discovered the polio vaccine, it adopted a new mission, "fighting birth defects", which was recently changed to a vaguer goal of "breakthrough for babies", rather than disbanding. You'll note that that they strongly pushed for a true cure. It was only afterwards where they had organization problems. You'll also note that those affected by polio still needed care, so the organization was still useful even after the vaccine. Similarly, there were a large number of tuberculosis organization. They too changed mission after effective treatments were found. The Saranac Laboratory for the Study of Tuberculosis, for example, became the Trudeau Sanatorium, which then closed when an effective TB treatment was discovered. More famously, the National Association for the Study and Prevention of Tuberculosis, after the TB treatment discovery, became the American Lung Association. Can you point to real-world examples where was a "true cure" but where organizations pushing for the cure ended up delaying the result, due likely to a conflict of interest with major sponsors? Because the historical record suggests that the organizations are more likely to continue to exist be changing focus, then by suppressing or delaying a cure. Regarding another aspect of #2, no one knows what a diabetes treatment might be. It could be an expensive treatment. It could take several years for a cure to take effect. It could be a preventative, which only helps those without diabetes but not those who currently have it. It could help one type of diabetes but not another. Some of these are very financially rewarding. Since members of the ADA almost certainly have friends or relatives who have diabetes, they have a strong emotional reason to want success, independent of money. Since it's impossible to know beforehand if a certain treatment path will be successful, much less the financial possibilities of a successful treatment, it's hard to really game the system that way. Since multiple organizations are working on a cure, it's hard also to game all of the researchers. Mind you, there's no promise that there is a true cure for diabetes. But there are ways to manage it, hence the terminology. BTW, I don't know what you mean by "new word." The phrase "diabetes management" dates back to at least the 1970s. Eg, http://diabetes.diabetesjournals.org/content/21/Supplement_2/678.abstract http://diabetes.diabetesjournals.org/content/21/Supplement_2... is a 1972 article titled "Current Unsolved Problems in Diabetes Management", and a literature search finds many other references from that era. An n-gram search [1] suggests that the preferred phrase was "control of diabetes" until the early 1980s, with "diabetes management" overshadowing it by the mid-1990s. [1] The n-gram search URL is https://books.google.com/ngrams/graph?content=diabetes+management%2Ccontrol+of+diabetes&year_start=1800&year_end=2000&corpus=15&smoothing=3&share=&direct_url=t1%3B%2Cdiabetes%20management%3B%2Cc0%3B.t1%3B%2Ccontrol%20of%20diabetes%3B%2Cc0 https://books.google.com/ngrams/graph?content=diabetes+manag...

SoftwareMaven 12y ago
The beauty is there is always plausible deniability. But take diabetes (I'm speaking type 2 here, to be ckear) as an example: we know there are safe dietary interventions that result in controlled blood sugars and significant reductions in medication use. These diets have study after study showing their safety. Yet, when a person is diagnosed as diabetic, they are told to eat a diet opposite of what the studies show will manage their diabetes, all while being given a prescription to take more meds. Dietitians are openly hostile to a diet that literally saves people's limbs. If you look at how the sponsorship model works in these orgs, companies are essentially buying the ability to provide continuing education. And while I don't necessarily believe the sponsors are out-right lying, I do think they are presenting a very one-sided view. There is a further problem that we saw as soon as the USDA published its food guide (a document that hasn't changed substantially in 30 years): the government now had a baseline of what research should try to prove. If your hypothesis didn't follow the orthodoxy, you lose your funding and perhaps your job. Diabetes is a complex illness. We don't know the actual cause, and we don't know what actually will cure it, but today's pharmacological path sells lots of drugs and results in lots of neuropathy, amputations, heart disease and dementia. Hardly what I would call managing. It's not a given that a strong focus on diet would change anything, but it might. It's worth a try. I fully admit to being biased. It is not only possible, but likely, that I overstated my case on TLAs caring more for themselves. Certainly, tuberculosis organizations did wonderful things. It does make me wonder if we passed a point somewhere where corporate interests in profits at any expense overshadowed the health of people. I don't like that hypothesis (I don't believe people, in general, are that selfish), so I am actively looking for alternatives. Understanding the cause helps us solve the problem.
- dalke 12y ago
  The ugly is there's always the possibility of falsely accusing people. Is there any way for the ADA to show itself unaffected other than getting rid of sponsorship, and of it does, would the result be worse for those with diabetes? I find it easier to believe that a diabetes researcher whose parents have diabetes is less likely to be concerned about the profit/loss statement of a sponsoring company and more concerned about the parents. I also find it harder than you to believe there is consistent capture across all research organizations in the world. I agree that the USDA food guide is incorrectly and unduly influenced by money and politics. But that's not the only food guide in the world and the US isn't the only research system. Other countries also have different economic goals that the US system. If a country has a single-payer national health care, and fund health research, then it's more likely to fund research in ways to reduce its health care payments. While I agree that pharma money can and does buy influence, especially when things are ambiguous, I think that big inconsistencies across different health care and research systems is hard to pull off. I also think orthodoxy is hard to enforce in the way you suggest, especially since there's a long practice of unorthodox publications becoming part of the new orthodoxy, even to the point of winning the Nobel Prize. Regarding diet, the diabetes literature is vast and I know very little of it. I know that those with diabetes are told to stop eating as much sugar. I'm surprised to hear that the opposite - eating more sugar - is the better diet. It's more likely that I don't understand your point. In a cursory review (I read care.diabetesjournals.org/content/34/1/14.full ) it seems that: > Observational studies have also shown that diets rich in vegetables and low in red meat and whole-fat dairy products are associated with a decreased risk of diabetes, whereas dietary patterns rich in red meats, processed foods, refined grains, and sweets increase diabetes risk > Recently, a clinical trial showed that, compared with a low-fat diet, a MedDiet allowed better glycemic control and delayed the need for antidiabetes drug treatment in patients with newly diagnosed diabetes (11). However, the role of the MedDiet in the prevention of diabetes has not been tested in a clinical trial. Which safe dietary interventions studies are you talking about? How are they different from, say, the CDC recommendations?

by dalke 12y ago

SoftwareMaven 12y ago

The beauty is there is always plausible deniability. But take diabetes (I'm speaking type 2 here, to be ckear) as an example: we know there are safe dietary interventions that result in controlled blood sugars and significant reductions in medication use. These diets have study after study showing their safety. Yet, when a person is diagnosed as diabetic, they are told to eat a diet opposite of what the studies show will manage their diabetes, all while being given a prescription to take more meds. Dietitians are openly hostile to a diet that literally saves people's limbs. If you look at how the sponsorship model works in these orgs, companies are essentially buying the ability to provide continuing education. And while I don't necessarily believe the sponsors are out-right lying, I do think they are presenting a very one-sided view. There is a further problem that we saw as soon as the USDA published its food guide (a document that hasn't changed substantially in 30 years): the government now had a baseline of what research should try to prove. If your hypothesis didn't follow the orthodoxy, you lose your funding and perhaps your job. Diabetes is a complex illness. We don't know the actual cause, and we don't know what actually will cure it, but today's pharmacological path sells lots of drugs and results in lots of neuropathy, amputations, heart disease and dementia. Hardly what I would call managing. It's not a given that a strong focus on diet would change anything, but it might. It's worth a try. I fully admit to being biased. It is not only possible, but likely, that I overstated my case on TLAs caring more for themselves. Certainly, tuberculosis organizations did wonderful things. It does make me wonder if we passed a point somewhere where corporate interests in profits at any expense overshadowed the health of people. I don't like that hypothesis (I don't believe people, in general, are that selfish), so I am actively looking for alternatives. Understanding the cause helps us solve the problem.

dalke 12y ago
The ugly is there's always the possibility of falsely accusing people. Is there any way for the ADA to show itself unaffected other than getting rid of sponsorship, and of it does, would the result be worse for those with diabetes? I find it easier to believe that a diabetes researcher whose parents have diabetes is less likely to be concerned about the profit/loss statement of a sponsoring company and more concerned about the parents. I also find it harder than you to believe there is consistent capture across all research organizations in the world. I agree that the USDA food guide is incorrectly and unduly influenced by money and politics. But that's not the only food guide in the world and the US isn't the only research system. Other countries also have different economic goals that the US system. If a country has a single-payer national health care, and fund health research, then it's more likely to fund research in ways to reduce its health care payments. While I agree that pharma money can and does buy influence, especially when things are ambiguous, I think that big inconsistencies across different health care and research systems is hard to pull off. I also think orthodoxy is hard to enforce in the way you suggest, especially since there's a long practice of unorthodox publications becoming part of the new orthodoxy, even to the point of winning the Nobel Prize. Regarding diet, the diabetes literature is vast and I know very little of it. I know that those with diabetes are told to stop eating as much sugar. I'm surprised to hear that the opposite - eating more sugar - is the better diet. It's more likely that I don't understand your point. In a cursory review (I read care.diabetesjournals.org/content/34/1/14.full ) it seems that: > Observational studies have also shown that diets rich in vegetables and low in red meat and whole-fat dairy products are associated with a decreased risk of diabetes, whereas dietary patterns rich in red meats, processed foods, refined grains, and sweets increase diabetes risk > Recently, a clinical trial showed that, compared with a low-fat diet, a MedDiet allowed better glycemic control and delayed the need for antidiabetes drug treatment in patients with newly diagnosed diabetes (11). However, the role of the MedDiet in the prevention of diabetes has not been tested in a clinical trial. Which safe dietary interventions studies are you talking about? How are they different from, say, the CDC recommendations?