Anecdotally Speaking

The superfluous, a very necessary thing. --voltaire

Sunday, January 07, 2007


Saving Lives Every Day

The last patient on a busy Friday was a friend of mine. He came in with his wife. We have very successfully treated the effects of his so-called metabolic syndrome. His blood pressure and cholesterol numbers have reached the established targets and he has recently shed ten pounds of extra weight.

He was there to discuss the results of a two-hour post-prandial glucose tolerance test. His fasting blood sugars have been normal, even his hemoglobin A1c has been normal, but the 2 hr pp result was 185. By definition, this would place him in the category of "impaired glucose tolerance," a common development in someone with metabolic syndrome. Some would say he was now a "borderline diabetic."

We spent forty-five minutes before going home for the weekend discussing the significance of the result for him. We talked about the physiology of insulin resistance, beta-cell function and the current theories related to the development of Type II Diabetes. I wanted him to make an intelligent choice out of the myriad of therapeutic options he faced.

The three of us settled on a therapeutic strategy that they were comfortable with and that I think makes sense. From my experience with these things, I expect to see impressive results. I expect to see his glucose metabolism normalize, at least in the short-term, staying normalized perhaps for many years to come.

I may have saved his life that day. Our work on that Friday afternoon may have started a chain of events that prevents diabetes, a stroke, a heart attack or at least postpones such things for years, perhaps decades. I may have given him a longer, healthier life. I will never know, but there is a chance that I might have.

It gives me considerable satisfaction to improve people's lives and health in this way. I expect to live, age, retire and die with these people. As we all grow old together I expect to see the fruits of my labors, the benefits that our current evidence based medical practice is achieving, reducing risk factors and managing chronic diseases effectively.

We are already beginning to see that people are living longer, healthier lives, living well into their nineties, healthy, strong, with their wits about them, enjoying life. This is a great gift to give people. That is what I like to think that I am doing, giving this gift of life and health.

HI Dr. David,
I read a few of your posts. I too have been in many of the same situations, and find many of your viewpoints very accurate - drug names, affecting people's lives more than you will ever know. Good work! You should be proud. Medicine has come such a long way and it's a pleasure knowing that as physicians we can achieve what we dream of and keep that helper spirit in the community. Likewise, I agree that we should make things somewhat simpler, but the problem for us lies in the drug manufacturers costing patients so much due to the amount of bureaucracy involved and insurance companies making so much money off of everyone. Trade names, in my view, would cost much less if less went to advertising and campaigns, and more into research. Many patients don't take their meds unless they can buy them. The generic names are getting ridiculous, and I wish we could write more trade names.... my .02
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