Transplant Industry Hypocrisy

[NDXUFan]

I'm not sure where the hypocrisy is. The officers are being paid market value for their work. I can't tell how long it took to have that much of a fund balance. Do you want them to give some cash to everyone on dialysis in the greater Los Angeles area? There must be thousands of patients.

I don't think giving cash to dialysis patients is going to help increase the pool of donors - living or deceased. I'm not sure what point you were trying to make there. However, I see nothing wrong with compensating a donor for their time - like Australia's health system is now doing. I also don't see a problem with some of that UNOS money going to pay for deceased donor's funeral services. To me, that is not greed, but a fair compensation for a major gift/event. I would only support it if Medicare and/or private insurance covered that payment. I do not think it should be up to the individual organ transplant recipient.

KarenInWA

So, what price will these "great" decision makers pay if they are wrong?

[jeannea]

If they are wrong about what?

[NDXUFan]

If they are wrong about what?

They are the ones who started this stupid policy to begin with, what does 100,000 people waiting for a kidney, tell you?

[jeannea]

That tells me nothing about them and a lot about people not willing to be donors. You still haven't said what they would be so wrong about that they should pay. There are millions of people who won't donate when they're dead and definitely won't when alive. That speaks to their values.

[NDXUFan]

That tells me nothing about them and a lot about people not willing to be donors. You still haven't said what they would be so wrong about that they should pay. There are millions of people who won't donate when they're dead and definitely won't when alive. That speaks to their values.

So, they should be willing to take an incredible amount of risk for no compensation, where else in the world does this happen?  Honestly, I am not sure how many people really know about transplant donation, many have given me a clueless look.

[Hemodoc]

Altruistic donation would be at risk of a paid donor system.  The new paired donations and donor chains has improved matching kidneys and most of these are started by an unrelated altruistic donor. The numbers of altruistic donors is on the rise.

The real issue with the high number of people on the organ wait list for kidney patients is the large number of patients who could have prevented ESRD by poor control of obesity which leads to HTN and diabetes and CKD all on its own.  Addressing prevention is the best way to impact the number of renal transplants needed.

As far as effects on donors, there are absolute risks of renal donation with a small percentage who die from the procedure. Vendors in Pakistan and other nations demonstrate no long term economic benefit and at increased risk of physical debility.

http://organdonorincentives.org/wordpress/wp-content/uploads/2010/01/AST-Pakistan.pdf

This is at the heart of the ethical considerations using a paid organ system where the coercion of the financial gain could lead someone to place their on life at risk. In addition, the poor and disenfranchised would be the fodder for such a system which sets off an entirely different aspect of the ethical concerns when considering an organ market.

It is simply a bad idea ethically and practically, who is going to pay for these things? Exploitation of poor people who would consider selling a kidney is an ethical situation we should not venture.

[Henry P Snicklesnorter]

.

[NDXUFan]

Altruistic donation would be at risk of a paid donor system.  The new paired donations and donor chains has improved matching kidneys and most of these are started by an unrelated altruistic donor. The numbers of altruistic donors is on the rise.

The real issue with the high number of people on the organ wait list for kidney patients is the large number of patients who could have prevented ESRD by poor control of obesity which leads to HTN and diabetes and CKD all on its own.  Addressing prevention is the best way to impact the number of renal transplants needed.

As far as effects on donors, there are absolute risks of renal donation with a small percentage who die from the procedure. Vendors in Pakistan and other nations demonstrate no long term economic benefit and at increased risk of physical debility.

http://organdonorincentives.org/wordpress/wp-content/uploads/2010/01/AST-Pakistan.pdf

This is at the heart of the ethical considerations using a paid organ system where the coercion of the financial gain could lead someone to place their on life at risk. In addition, the poor and disenfranchised would be the fodder for such a system which sets off an entirely different aspect of the ethical concerns when considering an organ market.

It is simply a bad idea ethically and practically, who is going to pay for these things? Exploitation of poor people who would consider selling a kidney is an ethical situation we should not venture.

NDXUFan:
HemoDoc, we agree on many issues in the dialysis industry.  However, the claim that obesity causes diabetes has simply not been proven.  To blame dialysis patients for that issue is intellectually false and intellectually lazy.  Every Academic Nephrologist has told me that the cause of type II diabetes is simply unknown.  If you are interested, I am willing to give your their names and institutions, privately.  Distinguished Professor of Nephrology Jerome Kassirer and Former Head Editor of the New England Journal of Medicine has stated in public that, "Losing weight does not improve your health."  Who is going to pay for these things, who is currently paying for dialysis at $100,000 per year to our pal, Kent Thiry and the Billing King, Davita?  Who is being forced to give a kidney, as you know, fraud is punishable by law.  I worked in the welfare building in a major metro area and when people run out of arguments, they cite the poor.  This argument has been used for years and years.  Is it ethical to give someone a kidney transplant or force them to be tortured by Thiry and Davita the Billing King?  Unlike most of you, I have worked with the poor for many years, I think that argument is total bunk or bullhockey.  If you want to talk about group in need of ethics, Thiry, Davita, and Fresenius need to be in the front of the line.  Ethics is a matter of subjective opinion and in that area, Davita and Fresenius are receiving an "F."  You think we could not afford kidney transplants compared to what we are paying your buddies at the Billing King, you have to be joking?  So, I am curious, who appointed you as the decision maker of costs and benefits for someone else?  We already have a system like that now, how is that working for you and the other patients?   The donor has the most to lose, why cannot they not be compensated for that risk?  You were compensated for the risk, time, effort, and med school, it took to become a physician.  I am curious, why should you have been compensated for those factors and the kidney donor should not be?  I have to laugh like crazy about people who are making out like corporate executives who state that donors should not be paid.   Many of these individuals need to be told to mind their own business and practice what they preach, which the majority of the time, they consistently fail to do.

[Dman73]

Many people will not sign a donor card feel that they will not get the best effort at saving their lives.

[Hemodoc]

Altruistic donation would be at risk of a paid donor system.  The new paired donations and donor chains has improved matching kidneys and most of these are started by an unrelated altruistic donor. The numbers of altruistic donors is on the rise.

The real issue with the high number of people on the organ wait list for kidney patients is the large number of patients who could have prevented ESRD by poor control of obesity which leads to HTN and diabetes and CKD all on its own.  Addressing prevention is the best way to impact the number of renal transplants needed.

As far as effects on donors, there are absolute risks of renal donation with a small percentage who die from the procedure. Vendors in Pakistan and other nations demonstrate no long term economic benefit and at increased risk of physical debility.

http://organdonorincentives.org/wordpress/wp-content/uploads/2010/01/AST-Pakistan.pdf

This is at the heart of the ethical considerations using a paid organ system where the coercion of the financial gain could lead someone to place their on life at risk. In addition, the poor and disenfranchised would be the fodder for such a system which sets off an entirely different aspect of the ethical concerns when considering an organ market.

It is simply a bad idea ethically and practically, who is going to pay for these things? Exploitation of poor people who would consider selling a kidney is an ethical situation we should not venture.

NDXUFan:
HemoDoc, we agree on many issues in the dialysis industry.  However, the claim that obesity causes diabetes has simply not been proven.  To blame dialysis patients for that issue is intellectually false and intellectually lazy.  Every Academic Nephrologist has told me that the cause of type II diabetes is simply unknown.  If you are interested, I am willing to give your their names and institutions, privately.  Distinguished Professor of Nephrology Jerome Kassirer and Former Head Editor of the New England Journal of Medicine has stated in public that, "Losing weight does not improve your health."  Who is going to pay for these things, who is currently paying for dialysis at $100,000 per year to our pal, Kent Thiry and the Billing King, Davita?  Who is being forced to give a kidney, as you know, fraud is punishable by law.  I worked in the welfare building in a major metro area and when people run out of arguments, they cite the poor.  This argument has been used for years and years.  Is it ethical to give someone a kidney transplant or force them to be tortured by Thiry and Davita the Billing King?  Unlike most of you, I have worked with the poor for many years, I think that argument is total bunk or bullhockey.  If you want to talk about group in need of ethics, Thiry, Davita, and Fresenius need to be in the front of the line.  Ethics is a matter of subjective opinion and in that area, Davita and Fresenius are receiving an "F."  You think we could not afford kidney transplants compared to what we are paying your buddies at the Billing King, you have to be joking?  So, I am curious, who appointed you as the decision maker of costs and benefits for someone else?  We already have a system like that now, how is that working for you and the other patients?   The donor has the most to lose, why cannot they not be compensated for that risk?  You were compensated for the risk, time, effort, and med school, it took to become a physician.  I am curious, why should you have been compensated for those factors and the kidney donor should not be?  I have to laugh like crazy about people who are making out like corporate executives who state that donors should not be paid.   Many of these individuals need to be told to mind their own business and practice what they preach, which the majority of the time, they consistently fail to do.

Actually, I am quite familiar with Jerome, he was my ex-sister in laws Mentor at Harvard. My ex-wife often had dinner with Jerome. Nevertheless, there is a definite correlation between obesity and Type II diabetes. Not sure where you got your information, but that is not in dispute. You state it has not been "proven." Well shucks, that applies to about 2/3rds of medicine. So thanks for calling me a liar and lazy, but no thanks.

Jerome's contention is that calling obesity a disease fuels the billion dollar industry dealing in pharmaceuticals and such. He has a point with that, but understanding the mechanism of insulin resistance, metabolic syndrome and diabetes, yes there is an absolute correlation with obesity.

As far as your considerations of my ethical constraints, just because you disagree with my position does not make intellectually dishonest and lazy. Get a grip man.

[obsidianom]

There is strong correlation between weight gain /obesity and type 2 diabetes. I have treated diabetics for 25 years and was trained in a residency with diabetes as the main disease we saw. The research is clear and real life patients back it up. The trend toward higher weight now in society and increase in diabetes incidence is strongly correlated.
Insulin resistance ocurrs often with obesity because fat cells are an organ themselves and they secrete hormones that cause insulin resistance . More and larger fat cells leads to insulin resistance. That is not a drug industry lie. I have many issues with the pharm industry but this isnt one of them.
Lets all play nice here also. Getting personal isnt going to help anyone. 

[Bill Peckham]

I'd say this is relevant: Popular Science (the magazine) is shutting off their comment section online. As the article says a "politically motivated, decades-long war on expertise has eroded the popular consensus on a wide variety of scientifically validated topics. Everything, from evolution to the origins of climate change, is mistakenly up for grabs again." Now too even the impact of obesity on diabetes is something anonymous internet commentators call into question.


Trolling the internet is all very amusing but trolling debases the the community, it corrodes understanding. Trolling isn't harmless.

[NDXUFan]

Altruistic donation would be at risk of a paid donor system.  The new paired donations and donor chains has improved matching kidneys and most of these are started by an unrelated altruistic donor. The numbers of altruistic donors is on the rise.

The real issue with the high number of people on the organ wait list for kidney patients is the large number of patients who could have prevented ESRD by poor control of obesity which leads to HTN and diabetes and CKD all on its own.  Addressing prevention is the best way to impact the number of renal transplants needed.

As far as effects on donors, there are absolute risks of renal donation with a small percentage who die from the procedure. Vendors in Pakistan and other nations demonstrate no long term economic benefit and at increased risk of physical debility.

http://organdonorincentives.org/wordpress/wp-content/uploads/2010/01/AST-Pakistan.pdf

This is at the heart of the ethical considerations using a paid organ system where the coercion of the financial gain could lead someone to place their on life at risk. In addition, the poor and disenfranchised would be the fodder for such a system which sets off an entirely different aspect of the ethical concerns when considering an organ market.

It is simply a bad idea ethically and practically, who is going to pay for these things? Exploitation of poor people who would consider selling a kidney is an ethical situation we should not venture.

NDXUFan:
HemoDoc, we agree on many issues in the dialysis industry.  However, the claim that obesity causes diabetes has simply not been proven.  To blame dialysis patients for that issue is intellectually false and intellectually lazy.  Every Academic Nephrologist has told me that the cause of type II diabetes is simply unknown.  If you are interested, I am willing to give your their names and institutions, privately.  Distinguished Professor of Nephrology Jerome Kassirer and Former Head Editor of the New England Journal of Medicine has stated in public that, "Losing weight does not improve your health."  Who is going to pay for these things, who is currently paying for dialysis at $100,000 per year to our pal, Kent Thiry and the Billing King, Davita?  Who is being forced to give a kidney, as you know, fraud is punishable by law.  I worked in the welfare building in a major metro area and when people run out of arguments, they cite the poor.  This argument has been used for years and years.  Is it ethical to give someone a kidney transplant or force them to be tortured by Thiry and Davita the Billing King?  Unlike most of you, I have worked with the poor for many years, I think that argument is total bunk or bullhockey.  If you want to talk about group in need of ethics, Thiry, Davita, and Fresenius need to be in the front of the line.  Ethics is a matter of subjective opinion and in that area, Davita and Fresenius are receiving an "F."  You think we could not afford kidney transplants compared to what we are paying your buddies at the Billing King, you have to be joking?  So, I am curious, who appointed you as the decision maker of costs and benefits for someone else?  We already have a system like that now, how is that working for you and the other patients?   The donor has the most to lose, why cannot they not be compensated for that risk?  You were compensated for the risk, time, effort, and med school, it took to become a physician.  I am curious, why should you have been compensated for those factors and the kidney donor should not be?  I have to laugh like crazy about people who are making out like corporate executives who state that donors should not be paid.   Many of these individuals need to be told to mind their own business and practice what they preach, which the majority of the time, they consistently fail to do.

Actually, I am quite familiar with Jerome, he was my ex-sister in laws Mentor at Harvard. My ex-wife often had dinner with Jerome. Nevertheless, there is a definite correlation between obesity and Type II diabetes. Not sure where you got your information, but that is not in dispute. You state it has not been "proven." Well shucks, that applies to about 2/3rds of medicine. So thanks for calling me a liar and lazy, but no thanks.

Jerome's contention is that calling obesity a disease fuels the billion dollar industry dealing in pharmaceuticals and such. He has a point with that, but understanding the mechanism of insulin resistance, metabolic syndrome and diabetes, yes there is an absolute correlation with obesity.

As far as your considerations of my ethical constraints, just because you disagree with my position does not make intellectually dishonest and lazy. Get a grip man.

   



The IU Nephrologist of over 30 years of experience told me that they did not know what was the cause of diabetes, along with the University of Cincinnati Nephrologist of 50 years experience.  My primary care physician and endocrinologist had Dr. Kassirer in Medical school.  The IU Nephrologist said that many in Nephrology are lazy and unwilling to research alternatives to In-Center dialysis.  I quote, "If In-Center dialysis works for them, they are too lazy to research anything else."  Please explain to me why they are so many that work in dialysis who are grossly overweight and are not diabetics?  Many academic endocrinologists have publicly stated that most diabetic cases are people over 50, because their system simply quits making insulin, not their weight.  Professor Emertius of Organic Chemistry Joel Kauffman(14 drug patents and 100 peer reveiwed publications) stated that "The BMI index has never been scientifically proven."  I had a number of hard science people look at the claim that "400,000 people die from obesity."  They stated that the study was mathematically incorrect and the IU Nephrologist said the study was a bunch of "Nonsense." 

I would contend that one of the reasons that people become diabetics is a lack of sleep over a time span of years.  I did not have any health issues of any kind until I worked the night shift for 20 years, except when I was born with pneumonia.  IU has stated that, "controlling blood sugar levels without the correct amount of sleep is almost impossible."  In addition, my body fat was very, very low and I could bench press 450 pounds and I was able to pass a very stressful police physical, how can that be?  I would love to see you try to tackle Jerome "The Bus" Bettis, 5'11" 260, top 5 rusher in NFL history.  That is a task not even I would attempt, I am not crazy.  Here is Bettis running over Brian Urlacher of the Chicago Bears:   http://www.youtube.com/watch?v=Fa1TSaKmG2o  How many thin people do you think that could beat Bettis running down the football field, not very many.  The IU Nephrologist said that many years ago, he figured out that people were not all the same.  It would be a great thing if most of medicine would realize that basic fact as well.  Yes, I realize that stereotyping is a much easier way.....   New Jersey Governor Chris Christie has great blood work.  Yet, physicians who have never, ever examined him, claim he is going to "drop dead" at any moment.  What is the basis for that claim? 

[NDXUFan]

There is strong correlation between weight gain /obesity and type 2 diabetes. I have treated diabetics for 25 years and was trained in a residency with diabetes as the main disease we saw. The research is clear and real life patients back it up. The trend toward higher weight now in society and increase in diabetes incidence is strongly correlated.
Insulin resistance ocurrs often with obesity because fat cells are an organ themselves and they secrete hormones that cause insulin resistance . More and larger fat cells leads to insulin resistance. That is not a drug industry lie. I have many issues with the pharm industry but this isnt one of them.
Lets all play nice here also. Getting personal isnt going to help anyone.

Ok, then, why are Academic Nephrologists with many years of experience telling me that they do not know what causes Type II diabetes?  The Mayo and The Cleveland Clinic have stated that they did not know what causes diabetes. 

[NDXUFan]

I'd say this is relevant: Popular Science (the magazine) is shutting off their comment section online. As the article says a "politically motivated, decades-long war on expertise has eroded the popular consensus on a wide variety of scientifically validated topics. Everything, from evolution to the origins of climate change, is mistakenly up for grabs again." Now too even the impact of obesity on diabetes is something anonymous internet commentators call into question.


Trolling the internet is all very amusing but trolling debases the the community, it corrodes understanding. Trolling isn't harmless.

 


Many MIT scientists do not agree with your contention about climate change.  You cannot deny that the drug industry has made billions in profits off of the cholesterol theory, while too many people are complaining of side effects of statins.  In other words, people who disagree with the status quo, should be "shut up."  Modern insulin medications are great and outstanding for the most part.....  The day will come when someone will disagree with your beliefs or opinions, and they will want to silence you.  My family left Nazi Germany in 1933.....  Just because I disagree with your opinons, I am not a "troll."  Many push ideas and theories because they receive research funding or MONEY.  Bill, I thought you were opposed to that sort of thing?  My view is that individuals do not have the right to force their beliefs on other people, it is just that simple.  Michelle Obama preaches a certain style of eating, while she stuffs fast food in her face, ice cream, and God knows what else, can we say hypocrisy?  In other words, the rules are for thee, but, not for me.  Remember this? 

Amendment I
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.

Do these rights apply to some people or every American citizen? 

[amanda100wilson]

"My view is that individuals do not have the right to force their beliefs on other people, it is just that simple".


Hmm, seems to me that is exactly what you are trying to do, and furthermore, not respecting the opinions of others.  Just a question.  Why are you so defensive about the link between obesity and diabetes?

[obsidianom]

There is strong correlation between weight gain /obesity and type 2 diabetes. I have treated diabetics for 25 years and was trained in a residency with diabetes as the main disease we saw. The research is clear and real life patients back it up. The trend toward higher weight now in society and increase in diabetes incidence is strongly correlated.
Insulin resistance ocurrs often with obesity because fat cells are an organ themselves and they secrete hormones that cause insulin resistance . More and larger fat cells leads to insulin resistance. That is not a drug industry lie. I have many issues with the pharm industry but this isnt one of them.
Lets all play nice here also. Getting personal isnt going to help anyone.

Ok, then, why are Academic Nephrologists with many years of experience telling me that they do not know what causes Type II diabetes?  The Mayo and The Cleveland Clinic have stated that they did not know what causes diabetes.
[/quo
I realized the problem here. You are thinking in absolutes. This thing or that thing are THE cause of an illness.. That is a common error people make. medicine doesn't really work that way. Most problems are a complex combination of factors with genetics being the most important.
Yes I would agree we don't know exactly what CAUSES diabetes .But we do know that some of the factors are genetics, diet and weight. It is almost a combination of these and possibly other factors.
Just because weight alone doesn't cause diabetes , doesn't mean it isn't related strongly.
You can always point to people who beat the odds. Just look at how SOME smokers can live to be 100 . That dosesnt prove smoking doesn't kill. Its just that some people defy the odds. Its all odds and percentages , but rarely absolute.
I am smart enough to know we don't have all the answers. We just have educated guesses. medicine is an ART, NOT a SCIENCE. Remember that. Your science people sometimes forget that.

[obsidianom]

One other point on weight gain and diabetes. There is a growing body of STRONG evidence that weight loss or bariatric surgery is a complete CURE for many diabetics. I have several patients of my own that this worked for.. they were very obese and on many oral daibetes meds with poor control. Then after the surgery and weight loss , no more meds at all and no glucose problems. This is another indicator that weight is related in some manner. Again it is not the ONLY cause but one strong factor.
 I am not a proponent of surgery in general as i was trained as a surgeon and am now very much anti many surgeries and no longer perform anything except minor office procedures. I have seen many sugeries go bad including my wife having a paralyzed stomach from a failed Fundiplication for GERD. She lives on a feeding tube now for food and water. of course this makes her dialysis easier as she has a "perfect"diet'.
 So I am not advocating bariatric surgery, only using it as an example of a cure for diabetes based on weight loss. 

[NDXUFan]

"My view is that individuals do not have the right to force their beliefs on other people, it is just that simple".


Hmm, seems to me that is exactly what you are trying to do, and furthermore, not respecting the opinions of others.  Just a question.  Why are you so defensive about the link between obesity and diabetes?

I am not, just stating facts that certain individuals do not want to hear or rocks their world view.  They can think whatever they want, I could care less.

[NDXUFan]

One other point on weight gain and diabetes. There is a growing body of STRONG evidence that weight loss or bariatric surgery is a complete CURE for many diabetics. I have several patients of my own that this worked for.. they were very obese and on many oral daibetes meds with poor control. Then after the surgery and weight loss , no more meds at all and no glucose problems. This is another indicator that weight is related in some manner. Again it is not the ONLY cause but one strong factor.
 I am not a proponent of surgery in general as i was trained as a surgeon and am now very much anti many surgeries and no longer perform anything except minor office procedures. I have seen many sugeries go bad including my wife having a paralyzed stomach from a failed Fundiplication for GERD. She lives on a feeding tube now for food and water. of course this makes her dialysis easier as she has a "perfect"diet'.
 So I am not advocating bariatric surgery, only using it as an example of a cure for diabetes based on weight loss.

Many in the medical profession love to stereotype individuals.  They have run all kinds of tests on me and each time, they strike out.  When they strike out, they are truly pissed off.  The reason that weight loss surgery is pushed so hard, is that it is a major money and profit maker for the hospitals(Wall Street Journal)


COMPARISON OF RISK AND BENEFIT


by Paul Ernsberger, Ph.D.-Northwestern  Case Western Reserve University

"Well, the gold standard in medicine is the controlled clinical trial. We don't go subjecting 100,000 people to a surgical procedure without doing a controlled clinical trial or dozens of clinical trials, and then looking at the results. Do you know how many clinical trials have been published on weight-loss surgery or gastric bypass? Zero. None of them have compared it to clinical conservative treatment and found it to be superior for life expectancy or for anything else other than, you know, risk factors. A number of trials have been started, and the final results have never been reported. We have to ask, you know, why haven't we seen the final results? I think it's because it's bad news. "


"The stomach is not simply passive sac for storing ingested food, but plays a complex role in the processing of nutrients. Surgical procedures which interfere with the normal operation of the stomach inevitably cause multiple problems. Unfortunately, no controlled trials have ever been run which include physical examination of the patients for possible side effects by independent doctors not associated with the surgeon.  In a rare instance of independent examination of bariatric surgery patient, a team of neurologists examined 500 patients who had received either gastric bypass or gastroplasty and found neurological complications (nerve or brain damage) in 5% of them (Neurology 37:196-200, 1987).  The patients were usually examined within a year after surgery, so the incidence of long-term neurological deterioration could be much higher than 5%. Possible damage to organs other than brain and nervous system has not been put under rigorous independent evaluation." 

Paul Ernsberger, Ph.D.
Associate Professor of Medicine, Pharmacology and Neuroscience
Case Western Reserve School of Medicine
10900 Euclid Avenue
Cleveland, OH 44106-4982
pre@po.cwru.edu

http://gastricbypass.netfirms.com/ernsbergerarticle.htm

[obsidianom]

Here is some proof. There has been research looking into Bariatric surgery as a cure for diabetes.  NOTICE THERE WAS ALSO A GREAT IMPROVEMENT IN DIABETIC NEPHROPATHY SHOWN , WHICH SHOULD INTEREST ALL OF US HERE.
YOUR PH.D WAS QUOTED 11 YEARS AGO ( ON TV)  ABOUT INFO FROM THE 1990S. THAT IS SO OUT OF DATE. MEDICINE CHANGES DRAMATICALLY IN 5 YEARS OR LESS. S
SO IF YOU ARE GOING TO QUOTE PEOPLE AS EXPERTS, DONT USE 10 TO 20 YEAR OLD DATA AND QUOTES.
ALSO, THE OPINION OF ONE PH.D. IS SIMPLY OPINION. THIS IS REAL DATA BY REPUTABLE RESEACHERS , NOT OPINION.


Gastric Bypass 'Cures' Diabetes in Almost a Third of Patients

Lisa Nainggolan
Sep 19, 2013


New Score Predicts Diabetes Remission Post Bariatric Surgery
Bariatric-Surgery Long-Term Metabolic Results
Gastric Bypass Puts Type 2 Diabetes Into Remission

=Publication of a new, albeit retrospective, study has shown that almost a third of obese patients with type 2 diabetes undergoing gastric bypass were effectively "cured" of their diabetes, being in complete remission as per the strictest definition possible that was maintained for 6 years after the surgery.
 
The researchers also found that patients undergoing such surgery significantly reduced their cardiovascular risk factors according to the Framingham Risk Score and that diabetic nephropathy either improved or was completely resolved; the latter is "remarkable," said the surgeon who led the study, Stacy A. Brethauer, MD, from the Cleveland Clinic, Ohio.
 
Of the patients, "27% had complete remission maintained for 5 years, and that is the operational definition of a 'cure' by [American Diabetes Association] ADA standards. Hopefully this will help people understand that the effects we see after these procedures are durable. Even in the patients who had some of their diabetes come back, the disease came back milder; we have changed the trajectory," he told Medscape Medical News
 
Dr. Brethauer first reported the results of the study at the American Surgical Association meeting in Indianapolis in April, and they have been published online today in the Annals of Surgery. His colleague, Philip Schauer, MD, also from the Cleveland Clinic, presented the findings at the Prediabetes and the Metabolic Syndrome 2013 Congress in Vienna, Austria around the same time.
 
At the time of the presentation at the surgery meeting, the study generated many comments and questions, which are included, together with Dr. Brethauer's responses, in the article.
 
One noted that this study adds to the findings of STAMPEDE, a randomized controlled trial also carried out at the Cleveland Clinic: "Today's paper adds even more proof. Not only does it work, but it works 5 years later. It is not totally new. We reported good results at 10 years. The Swedish colleagues reported at 20 years. But your paper was far more elegant and far more detailed," observed Walter J. Pories, MD, from East Carolina University, Greenville, North Carolina. Why, then, he wonders, are there still "cries for more evidence, more evidence?"
 
Dr. Brethauer replies that the surgical community must continue "to provide data to support the concept that this is a surgically treated disease. It is a major paradigm shift for our endocrinology colleagues to accept. And I think it is going to require time and a new generation of endocrinologists before they fully embrace this."
 
Talking of Cure is "Controversial and Provocative"

Dr. Brethauer explained to Medscape Medical News that while his study is not unique in reporting longer-term outcomes, it is one of the few to have used the strictest definition of remission, as per ADA criteria, "that a patient has to have HbA1c of 6% or less, normal fasting blood glucose [<100 mg/dL], and be completely off diabetes medications for one year."
 
In their study, the Cleveland Clinic researchers went back and examined the clinical outcomes of 217 patients with type 2 diabetes who underwent bariatric surgery between 2004 and 2007 and had at least 5 years of follow-up. The majority of patients (n = 162) underwent Roux-en-Y gastric bypass (RYGB), with the remainder undergoing gastric banding (n = 32) or sleeve gastrectomy (n = 23).
 
At a median follow-up of 6 years (range, 5–9 years), a mean excess weight loss of 55% was associated with mean reductions in HbA1c from 7.5% to 6.5% (P < .001) and fasting blood glucose (FBG) from 155.9 mg/dL to 114.8 mg/dL (P < .001).
 
Long-term complete remission, as per the ADA criteria, occurred in 24% of patients, and partial remission (HbA1c 6%–6.4%, FBG of 100–125 mg/dL for 1 year in the absence of antidiabetic medications) was observed in 26% of patients. In addition, a further 34% of patients improved their long-term diabetes control compared with presurgery status. There were 16% of patients who remained unchanged.
 
When only the RYGB patients were considered, 31% of patients achieved complete remission; 27% of bypass patients continuously sustained this for more than 5 years, the ADA definition of a "cure," the researchers note, although Dr. Brethauer observed that the use of this term with respect to type 2 diabetes "is still quite controversial and somewhat provocative."
 
Realistic Expectations; Diabetes Recurs but Legacy Effect

Dr. Brethauer and colleagues go on to say that it's now obvious that the remission rates first seen in short

[obsidianom]

Here is the intro to another journal article. It again points out weight gain and diabetes.

Introduction

The prevalence of obesity and the associated health consequences, including type 2 diabetes mellitus (T2DM), continues to rise.[1] The typical progression of T2DM is one of deteriorating β-cell function that requires an increasing amount of oral medical therapy and finally insulin treatment to achieve adequate glycemic control.[2] Ultimately, there is pancreatic β-cell failure.[3] Calorie restriction and subsequent weight loss have been shown to be effective treatment modalities of T2DM.[4] Caloric restriction can improve hyperglycemia through regulation of hepatic glucose production.[5] In addition to cumulative weight loss, the rapidity with which the weight loss is achieved also exerts an effect on glycemic control.[6] Unfortunately, most individuals are unable to maintain a reduced body weight through diet alone.[7] In contrast, weight loss achieved by bariatric surgery has been shown to result in a lesser degree of recidivism than nonsurgical treatments and is associated with marked improvement of glycemic control.[8]

[Simon Dog]

This is at the heart of the ethical considerations using a paid organ system where the coercion of the financial gain could lead someone to place their on life at risk.

The same could be said of coal mining, police work, fire fighting or working as a convenience store clerk - all cases of placing one's life at risk for financial gain.

And there is the job of "royal organ donor" (yes, really) in at least one country where a peasant is type matched to the king and given a great life - in return for agreeing to donate ANY organ should the king need it.

[KarenInWA]

I guess I just don't see compensating a live donor (be it kidney, liver, or bone marrow) for lost wages and time when not every donor will get their lost wages covered by work or short-term-disability. Up in BC Canada, I'm told by someone who received a kidney from a live donor that the hospital compensated his donor for lost wages. It only makes sense to me that this be done. In my personal case, my donor was retired and married, so she did not need to worry about losing income. But in reality, this does not happen that often, since not many retired folk are healthy enough for donation. Also, Australia is starting to compensate live donors on a trial basis. It will be interesting to see how that turns out.

KarenInWA

[kristina]

This is at the heart of the ethical considerations using a paid organ system where the coercion of the financial gain could lead someone to place their on life at risk.

The same could be said of coal mining, police work, fire fighting or working as a convenience store clerk - all cases of placing one's life at risk for financial gain.

And there is the job of "royal organ donor" (yes, really) in at least one country where a peasant is type matched to the king and given a great life - in return for agreeing to donate ANY organ should the king need it.

Hello Simon,

could you please tell me more about the "job" of the "royal organ donor" ? Where and when does/did it take place ?

Thanks from Kristina