{"id":4972,"date":"2016-08-01T11:34:20","date_gmt":"2016-08-01T17:34:20","guid":{"rendered":"http:\/\/admin.patheos.com\/blogs\/janetheactuary\/?p=4972"},"modified":"2016-08-01T11:34:20","modified_gmt":"2016-08-01T17:34:20","slug":"the-cdc-rent-seekers-or-cowboys-part-ii","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/the-cdc-rent-seekers-or-cowboys-part-ii.html","title":{"rendered":"The CDC: Rent-seekers or Cowboys, part II"},"content":{"rendered":"\n<\/head>

\"from<\/p>\n

So a while back, I read and wrote about<\/a> an article about an increase in maternal mortality in the U.S., and its woefully higher rates than other developed countries. \u00a0Turned out, the U.S. numbers were not meaningfully comparable to the rest of the world, because their definitions were different: the CDC deemed any maternal death within a year of the child\u2019s birth as \u201cmaternal mortality\u201d while the WHO (that is, the rest of the world) uses a 42-day standard.<\/p>\n

Why, I asked at the time, did the CDC use a standard that made the U.S. data useless for international comparison? \u00a0Were they rent-seekers, seeking advantage from making maternal mortality look worse, and in greater need of federal funds to fix the situation? \u00a0Or were they go-it-alone cowboys, simply convinced that the superiority of their method is great enough to override\u00a0any disadvantage in lack of comparability?<\/p>\n

Turns out, there\u2019s another example in an opinion column in today\u2019s Chicago Tribune, \u201cPrediabetes: The epidemic that never was, and shouldn\u2019t be<\/a>.\u201d \u00a0According to the authors,\u00a0Isabel Beshar and Hank Campbell, the CDC has been ratcheting down the threshold for diagnosing \u201cprediabetes\u201d ever-lower, to a cut-off that means that genuinely healthy people can, due to natural variability in blood sugar, go in for a routine test, and leave with a diagnosis \u2014 and, what\u2019s more, leave with a prescription for a medication, ordinarily intended for diabetes, that\u2019s now being used for \u201cprediabetes\u201d patients.<\/p>\n

And, they write,<\/p>\n

The United States has the lowest prediabetes cut-off points of high-income countries around the world, meaning that prediabetes gets diagnosed earlier and more frequently, leading to new patients and higher costs. In 2003, and then again in 2010, the American Diabetes Association shifted the prediabetes diagnostic threshold down, from 110 to 100 milligrams per deciliter for the finger-stick glucose test, and from 6.0 to 5.7 percent for the average blood sugar level (the HbA1C test).<\/p>\n

Other countries have pushed back. So has the World Health Organization, which has cautioned since 2006 that lower thresholds would needlessly double the prevalence of prediabetes and inadvertently implicate patients at minimal or no risk. In China, for example, adoption of the current ADA guidelines would result in 493 million new prediabetics.<\/p><\/blockquote>\n

Why is this happening?<\/p>\n

It\u2019s a gold mine for the pharmaceutical industry, thanks to the American Association of Clinical Endocrinologists\u2019 recommendation that diabetes drugs be used in patients with prediabetes. More diagnoses mean more sales, even though pharmaceutical interventions rarely work for prediabetes and their side effects are well reported.<\/p><\/blockquote>\n

Now, to be sure, the authors identify the culprits as the American Diabetes Association, but, at the same time, it is the CDC that gives the official imprimatur<\/em> to these thresholds and the resulting count of affected Americans.<\/p>\n

And I don\u2019t even think it\u2019s necessarily a matter of selling more drugs \u2014 I\u2019d have to know more about what\u2019s been defined as the standard of care for patients, and what actual medical practice is at the moment, and Beshar and Campbell only imply but don\u2019t actually state that patients at the low, rather than the high end of the range are being prescribed these pills. \u00a0I would guess it\u2019s more a matter of the government and others wanting to have a way of labeling overweight people as having a disease (beyond the existing approach of labeling the condition of being overweight as a disease) so as to add another dimension of urgency to the cause of greater government intervention.<\/p>\n

But wanting to add more tools to your anti-overweight cause is not suitable grounds for manipulating diagnoses.<\/p>\n

\u00a0<\/p>\n

image from pixabay; https:\/\/pixabay.com\/en\/diabetes-finger-glucose-test-776999\/; public domain<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"

So a while back, I read and wrote about an article about an increase in maternal mortality in the U.S., and its woefully higher rates than other developed countries. \u00a0Turned out, the U.S. numbers were not meaningfully comparable to the rest of the world, because their definitions were different: the CDC deemed any maternal death […]<\/p>\n","protected":false},"author":2209,"featured_media":4973,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[434,435],"class_list":["post-4972","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-cdc","tag-diabetes"],"yoast_head":"\nThe CDC: Rent-seekers or Cowboys, part II<\/title>\n<meta name=\"description\" content=\"So a while back, I read and wrote about an article about an increase in maternal mortality in the U.S., and its woefully higher rates than other developed\" \/>\n<meta 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