Tuesday, May 11, 2004

cost-effective medicine

I'm disturbed by stories saying diabetes screening is only cost-effective for people who have risk factors. I had the risk factor of having had a large baby, but my blood pressure and lipids are good and I am under 55 and have no family history so I wouldn't have come up otherwise. I'm so glad I insisted that my blood sugar be tested, which my doctor didn't think necessary, rather than not getting diagnosed until I had complications like many people.

Basically, screening isn't cost effective because people who are diagnosed early don't benefit very much. But that is clearly the fault of the medical establishment--people who are diagnosed early can do a lot to prevent complications and slow the progression of the disease, if they get helpful information from their doctors and use it. They don't. They get the American Diabetes Association recommendations, which recommend a fairly high carbohydrate, low fat diet. That maybe helps prevent heart disease, but it certainly doesn't slow the progression of diabetes. And they don't get an explanation of the costs and benefits of different approaches so they can find one that is comfortable for them.

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