Down on the PhRMA If you ask a car salesman if he thinks you should buy a car, is there any doubt about what the answer will be? Likewise, if you ask representatives of the Pharmaceutical Research and Manufacturers of America (PhRMA) if they think you should address a chronic health condition with drugs, it's inconceivable they'd say no. So when PhRMA (the advocacy organization for the major U.S. drug companies) commissioned a study to determine if patients diagnosed with type 2 diabetes are better off taking medication to treat the disease, you can imagine what the conclusion was. Three words: medicate, medicate, medicate. In several e-Alerts I've told you about some of PhRMA's efforts to portray the drug industry as a benevolent uncle who wants nothing more than to make everyone feel a little bit better. And these efforts are understandable. That's PhRMA's job. That's all they do: paint happy faces on the activities of giant drug companies. In other words, you've got to take anything coming from PhRMA with a grain of salt. But no salt grains were evident in a recent Associated Press (AP) article that detailed the diabetes study that reviewed insurance records of nearly 200,000 patients with type 2 diabetes. Results showed that over the course of one year, nearly one in five patients didn't use insulin or other drugs designed to treat their disorder. The AP article doesn't mention that most type 2 diabetics aren't prescribed insulin to manage their disease (insulin injections are mostly used by type 1 diabetics). And the study itself contains no reference to adverse side effects that might have caused patients to stop using other types of antidiabetic drugs. In a somewhat defensive tone, the authors of the study insist that it's not the price of prescription drugs that's driving healthcare costs through the roof, it's all those people who aren't taking their medication, resulting in unneeded hospitalizations. The implication: If only these reckless ner'do-wells would just be good and take their drugs, things would be so much better for everyone. Right. The drug companies aren't responsible for super-sized healthcare costs; it's the patients who are to blame. Thanks for enlightening us, PhRMA. The PhRMA study gives a passing reference to dietary modifications and increased exercise; the two lifestyle changes that are recommended for virtually every patient with type 2 diabetes. More emphasis is put on the concept of "undertreatment," which in this case refers to those patients who are not prescribed antidiabetic medicines or insulin, or who refuse to take these drugs after they're prescribed. What the study doesn't share is the direct results of medication compared to lifestyle changes. For that we can turn to a 2002 study published in the New England Journal of Medicine. The Diabetes Prevention Program Research Group at George Washington University (GWU) enrolled 3,234 overweight subjects who were not yet diabetic, but exhibited elevated glucose levels. They were randomly assigned to one of three groups: One group received 850 mg of the widely-used prescription drug metformin (Glucophage) twice each day, one group received a placebo, and the third group participated in, "an intensive program of lifestyle modification." The lifestyle program called for a minimum of two and a half hours of moderate exercise each week, while following a low- fat, low-calorie diet. Subjects in this group also participated in at least 16 one-on-one educational sessions on diet, exercise, and behavior modification. After following these subjects for nearly three years, the GWU team described the lifestyle changes as "significantly more effective than metformin." Incidence of diabetes was reduced about 30 percent with metformin use compared to placebo. But lifestyle changes cut the incidence rate by well over half - a full 58 percent. Plus, patients in the metformin group had six times more gastrointestinal side effects than those in the lifestyle group. In this study, "undertreatment" was clearly the safer and more effective treatment. Of course, lifestyle modification is easier said than done. Most of us would rather not think about the number of diets and exercise programs that we've started but didn't stay with. But when you're trying to manage type 2 diabetes, backsliding can have serious consequences. So it's no wonder that many people opt for a prescription drug safety net so they don't have to bet their health on their diet and exercise willpower. But there may be a safer safety net. In a recent issue of the journal Diabetes Care, researchers from the Chinese Medical Science Research Institute in Beijing investigated the glucose-lowering effects of Pycnogenol, based on reports from patients who said their need for insulin dropped off sharply after using Pycnogenol supplements. Many HSI members are familiar with Pycnogenol from previous e-Alerts. This natural antioxidant - extracted from pine bark - contains a variety of polyphenols with anti- inflammatory effects that have been shown to benefit the cardiovascular system. The Beijing team examined the effects of Pycnogenol on 30 subjects with type 2 diabetes. Along with a program of exercise and diet modification, each subject received Pycnogenol doses of 50, 100, 200, and 300 mg in three-week intervals. Compared with data collected at the outset of the study, subjects significantly lowered their fasting glucose levels with doses of 100 to 300 mg. More extensive studies are needed to confirm the effectiveness of Pycnogenol in managing type 2 diabetes, but this research illustrates that there are natural treatments that provide alternatives to drugs. For instance, in the e- Alert "Beef 'n' Butter" (4/20/04), I told you about the fatty acid called conjugated linoleic acid (CLA), which has been shown to aid in the management of glucose and insulin levels. The subjects in the GWU study had the assistance of researchers to help monitor their diets and exercise programs. This sort of scrutiny certainly makes it easier to stick with a lifestyle modification plan. But there's another way to get a little help if you need it. If you or someone you know has been diagnosed with type 2 diabetes or a pre-diabetic condition, I highly recommend a special report by Jonathan V. Wright, M.D., titled "10 Natural Ways to Stop Diabetes in its Tracks now." While the medical mainstream typically focuses on treatment, Dr. Wright's report will tell you how to recognize the signs of risk so you can prevent type 2 diabetes before it begins, and how to manage blood sugar levels without the expense and side effects of prescription drugs. Find out more about Dr. Wright's hidden diabetes warning signs and the most important steps that must be taken when the signs appear. Sources:
"Examination of Treatment Patterns and Effects of Medication- Taking Behaviors among Patients with Diabetes" Pharmaceutical Research and Manufacturers of America, 4/21/04, phrma.org
"Many Diabetics Going Without Medicine" Associated Press, 4/21/04, msnbc.msn.com
"Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention of Metformin" The New England Journal of Medicine, Vol. 346, No. 6, 2002, content.nejm.org
"French Maritime Pine Bark Extract Pycnogenol Dose- Dependently Lowers Glucose in Type 2 Diabetic Patients" Diabetes Care, Vol. 27, 2004, care.diabetesjournals.org
"Pycnogenol Helps Manage Diabetes" NutraIngredients.com, 3/22/04, nutraingredients.com
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