The post and comments that followed covered several related issues---inappropriate lumping of type 1 and type 2 diabetes, failure to advocate for patients, not enough emphasis on a cure---but I will focus on one. It seems Dr. Kahn is being accused of “dissing” diabetes technology:
It is frightening that someone like Kahn, who in his position with the ADA is arguably the most visible spokesperson for diabetes in this country, would deliver a speech essentially dissing the value of new diabetes technologies -- and at the country's top gathering of D-tech experts, no less!
OK, so did Kahn really dis new technology? Here’s an excerpt from the speech:
The ‘90s also gave birth to many other advances in technology without which we would have made little progress in controlling the ravages of the disease. Laser photocoagulation, insulin pumps, angioplasty and by-pass procedures, mono filaments for foot exams, sophisticated glucose meters, and many more technological advances, have given people with diabetes a far better life than was imagined even a decade or two earlier. They have certainly saved lives, improved many more lives, and made diabetes manageable for millions of people.
Kahn suggests a healthy skepticism towards new technology. He raises questions of evidence. But he’s not dismissive, at least in my reading. He’s not even suggesting technologies be subjected to the same scrutiny we apply to new drugs. I can think of many gadgets, bells and whistles, both in and outside the field of diabetes, which have survived such scrutiny despite a lack of proof of improvement in clinical outcomes. The proliferation in the 1980s of programmable functions in cardiac pacemakers and new modes in mechanical ventilators are just two examples. Many of these advances, while never passing the rigorous tests of evidence based medicine, remain available today to the benefit of individual patients.
Amy goes on:
Think of the ramifications. If the ADA comes out with an official position that there's no value in using an insulin pump, or a CGM system, or even a fingerstick meter if you're a Type 2 not on insulin, the Powers That Be will listen.
The ADA should follow the evidence. Although insulin pumps have no proven superiority over newer insulins they represent an alternative which should be available to patients with type 1 diabetes. I can understand patients’ concerns. I hope we never see the day when the patient has to wait a year after the doctor fills out a ream of paper in order to get a pump. That may happen if we go to a single payer system---not as a result of any influence of Richard Kahn or the ADA.
H/T to Kevin MD.