Legend Has It . . . How Diabetes Was Discovered and How That Makes Me Fat

The German physiologist Oskar Minkowki was the first person to identify the role of the pancreas in diabetes.  Legend has it that on a momentous day in 1889 Oscar  noticed that urine collected from his pancreatectomized dogs (dogs that had surgical removal of their pancreas) attracted a very large number of flies.  He is said to have "tasted" the urine and to have been struck by its sweetness.  (Only in 1889 could you get away with tasting dog urine.)  He then made a very astute observation and realized that the pancreas controlled blood sugar concentration and was a key factor in diabetes mellitus.
Thirty years later, Fredrick Banting and Charles Best identified insulin as the key hormone produced by the pancreas controlling the level of blood sugar.  However, what Oscare Minkowski couldn't taste was the very high level of acetone in the urine which is produced by the liver in the conversion of fat to ketone bodies.  Had Oscar lost his sense of taste, instead of noting the sweetness to the urine he might have noted the pungent smell of acetone.  He would have then concluded that the removal of the pancreas causes fatty acid metabolism to go awry.  He then would could have extended his hypothesis and concluded that the preeminent role of insulin was not in the control of blood sugar alone, but in the control of fat metabolism.
We have become fixated upon the function of insulin and its effect upon diabetes, and in doing so, we have neglected the fact that insulin has even greater effect upon the storage and use of fat and protein in the body.
A series of discoveries from the 1920s-1960s let to a revolution in the understanding of the role of insulin in fat metabolism.  At that time, fat was assumed to be relatively inert and carbohydrates were seen at the primary fuel for muscular activity (which is still commonly believed today).  The belief was that fat is used for fuel only after being converted in the liver to suspiciously toxic ketone bodies.  Forty years of research overturned this assumption, however, it had no influence upon mainstream thinking about fat gain and obesity.  In 1973 when all the details of fat metabolism had been worked out, Hilde Bruch, the foremost authority on childhood obesity, stated "it is amazing how little of this increased awareness . . . is reflected in the clinical literature on obesity."
JAMA just released it's compendium on obesity research and the simple science of insulin's effect on fatty acid metabolism is STILL being ignored. Instead, main stream medicine is starting to push patients toward a very expensive and risky gastric bypass surgery. This scares me.
Hippocrates said, "Let food be your medicine and let medicine be your food."  The body responds with hormonal effect to what we feed it and the science explaining this has been ignored. We have been brainwashed with the dogma that the "calorie is king."

Mayor Bloomburg eating donuts
two days after trans fat ban

Based on this we are now legislating food behavior.  New York has now banned trans fats by the New York City Board of Health and has legislated all soda sizes to no larger than 12 oz. We are creating health policy on bad science.  Let's go back and look at the science before we let our legislators start cooking for us, or soon our grocery stores will look like our government run school cafeterias offering school lunches.

What the ACA (Affordable Care Act) Means to Me

Yesterday morning I read the Michigan Osteopathic Association (MOA) and the American Osteopathic Association (AOA) statement's on the SCOTUS decision and got nauseated.

I was not surprised when I read that the American Medical Association is a comfortable socialist bed partner with the White House, we have had evidence of this for the last four years. But, I was notably surprised that the American Academy of Family Practioners joined them as the dirty mistress with their recent positive support.

However, I was physically nauseated when I read that the American Association of Colleges of Osteopathic Medicine "applauded the decision," that same SCOTUS decision that the AOA and the MOA took a position of quiet neutrality.  

To them all I say, "All that is necessary for the triumph of evil is that good men do nothing."  Doing nothing . . . that I what I see many of the medical society and organizations, including the AOA, doing. Doing nothing with quiet neutrality.  

They say, this is a "sticky" issue and there are strong feelings on both sides, and we have to approach this delicately. If I recall, similar words were issued when the Titanic sunk!

I cannot support the statement by the AOA that the passage of the Affordable Care Act demonstrates "significant strides have been made" to improve access and quality. 

This act has already priced at least 100 of my senior patient's out of insurance by causing an increase in their premiums by 100-500%, has made obtaining their current medications more difficult, and will likely make it impossible for me, a small business owner, to provide adequate insurance for my staff of 14 people as premiums continue to rise.  If I don't provide insurance for them, then I will be taxed out of business in 2014.

This is the largest tax increase in American history with twenty new taxes on each of us individually found within this bill.  It also brings 159 bureaucracies, 47 new governmental agencies, and adds 16,500 new IRS agents. This bill now makes the IRS the most powerful arm of the government.

I am appalled that the AOA and the MOA would release a statement that their position is one of neutrality. Do they not actively practice in the trenches and see what this bill is already doing to the good people, small or solo practice physician and seniors of these United States?

Because of this bill, I have already had a pay cut of 1.5% on Medicare reimbursement and will most likely receive another 1.5% on July 1st because the Medicare electronic prescribing submissions were "not qualified" according to Medicare and I can do nothing about it.

The decision that this bill is constitutional was NOT an overwhelming majority, it was split 50/50 and passed only because our senior Supreme Court Justice lost his spine.  This only accelerates the destruction of health care as we know it and will push our system to a single payer system within the next 3 years.

This mandate does not fix the SGR, medical liability reform, or adoption of improved clinical communications.  In fact, it appears to have made them worse by placing them further from our view and moving them off the table for the last 2 years.

A position of neutrality by the medical societies is interpreted by the lay public that we as physicians feel further socialization of health care paid for by increased governmental control and increased tax is what "every physician" wants. 

The only statement that I have read that seems to take a position other than weak political coddling is that issued by the American College of Osteopathic Family Practitioners (ACOFP).

Sincerely, mortified.

Adam Nally, D.O.

What Would Your TSA X-ray Say?

Said Hippocrates . . .

"Let food be your medicine, and let medicine be your food."

Health Care and Politics

I have been told by many that there are two things you never talk about: politics and religion.  I realize that I have broken these rules, but these seem to be the things that are most important in life and are at the forefront of the mind recently. 

It has been interesting to hear from my liberal friends and collegues about my last comments.  I find that the conversation and communication is important for two reasons.  First, truth is independant, and the only way to identify truth is to hear it, read about it, or find it through civil discussion with those around you. The truth about health care has been weighing upon my mind in the last year.

It has been upon my mind because it is what I do for 12-16 hours per day.  I am in the business of rendering care and attempting to provide the best care possible in few minutes I have with each patient.  But I am finding that political influences of both our state and nation have drastically affected the number of minutes I can spend, the type of care I can render and the choices I can offer to my beloved patients.  I have found that these political voices can no longer be silently ignored.  

As I have read, listened and discussed this with many around me (both conservative and liberal), I am finding there are really only two voices.  Those voices speak at various points along a spectrum of desired liberties, but there are really only two voices.  There are those voices that speak the language of the founders of this republic who understood that true freedom comes from liberty, and there are those that speak the voice of progressivism whos concepts of freedom are defined by various degrees of socialism. 

I have been accused of not understanding socialism and seeing all change in society as socialistic.  This is not the case.  Socialism, as it was defined in "school," is that society in which there is no private property. It is where the collective or governmental ownership oversees the distribution of goods and services. Socialism as defined by Marxist theory is a stage in society between capitalism and communism.  These political doctrines are founded in our understanding and acceptance of the concept of property ownership.  We see this in governments around the world in varying degrees in countries like France, Venisuala, Sweden, and Laos, etc.

Private property and liberty are insperable. We lose our liberty as the right to hold private property is removed. The difference in views between our country's founders and the progressives is their understanding of the conferrance of freedoms based on the liberties granted by ownership of private property.  Communism is defined as a society where ownership of private property does not exist.  In the words of Abraham Lincoln, "We all declare for liberty; but in using the same word we do not all mean the same thing.  With some the word liberty may mean for each man to do as he pleases with himself, and the product of his labor; while with others, the same word may mean for some men to do as they please with other men, and the product of other men's labor.  Here are two, not only different, but incompatible things, called by the same name liberty.  And it follows that each of the things is, by the respective parties, called by two different and incompatible names - liberty and tyranny."

How do these political ideologies relate to medicine?  Well, lets think about a three other concepts.  First, those things that make us different from every other country in the world are defined in our Declaration of Independance: 
   "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."
We believe that being created in equality, we each have the right to life, liberty and the pursuit of happiness.  This statement does not guarantee happiness, but states that we have a right to liberty and life.  We have a right to act in this life in those ways that will bring us liberty, the right do those things that allow us the ownership of personal property and seeking those things in our lives that bring us happiness.

Second, life is full of change.  Our society is different from what it was in 1776, the time when our founders wrote the words of the Declaration, and our society will be different 100 years from now.  Change is important; however, our assessment and acceptance of change must be done with prudence.  But, that which is lost in our society today is prudence.  Prudence is of the highest of virtues because its judgement is drawn from wisdom.  Prudence was exercised as a basis of society in 1776 because of man's view of himself before his maker.  Our Declaration states that these rights are "God given."  Today, many question even the existance of a maker, and prudence is lost. With prudence being lost in our society, our general ability to assess the way societal changes affect us now and in the future is greatly limited.

Third, it is important that we understand the definition of capitalism.  Capitalism is defined as an economic system characterized by private or corporate ownership of goods or services, by investments that are determined by private decision, and by prices, production, and the distribution of goods that are determined mainly by competition in a free market
So, how then does this relate you your medical care?  Your ability to obtain care relates you your understanding of what medical care actually is.  Medical care is essentially property.  You buy services. Medical care is a service or commodity, just as your home or car is a commodity with ownership. The progressive view goes beyond the statement that "men are created equal" and asserts that men should receive equally, a socialistic view.  They extrapolate that men should therefore recieve medical care equally as it paints medical care as a right.  Medical care is not a right.  Medical care is a commodity which is purchased.  Your body was designed to heal itself.  When disease, illness or injury occurs, assistance to those bodily functions of healing can and should be sought as the "pursuit of happiness."  Medical care is thereby a service that is rendered either through purchase or through a charitable act. 
 
So then the politics of medical care then also pertain to our liberties and our freedoms. Our government was designed as a republic for our protection and to ensure life, liberty and pursuit of happiness.  Our constitution provides an environment for us to seek our own happiness while not infringing upon the lives of those around us.  We are free then to seek happiness through our own inginuity, free to protect ourselves, and free to take individual risks.  When injury or illness arises, we are free to seek care and healing above and beyond what our body will do on its own. 
 
The progressive or socialistic view is that men have the right to recieve the same or equal care.  Seen as a right, the progressive government mandates this care.  The problem with this view is that our liberties are then taken away, because a politician decides what care is best and how often you can recieve it.  In a capitalistic society, the medical provider will attempt to provide the best most efficient care to be competative in that society.  In a socialistic society, the medical provider has no incetive to become better or to provide a better service, because the same service is mandated by the governmental politician.   Yes, the care is free, but your liberties of "pursuing happiness" through the type and quality of your care is now infringed upon, and your freedom is restricted. 
 
I am affraid that our so-called "liberals," as well as our progressive republicans in society, desire to recieve the benefits of socialism in a capitalistic society.  These two concepts are diametrically opposed to each other.  Capitalism, and the medical services created and rendered therein, cannot succeed in a socialistic society requiring limitation of liberty under the guise of "medical equality."
 
Our medical system is broken.  We have allowed our government to create programs like Medicare and Medicaid, socialistic programs, trying to create equality and limiting our liberty.  We are now dependant upon these medical insurance programs created and expanded 50 years ago under progressive presidencies and congress.  We, the children and grandchildren of these leaders, must now deal with the consequences of socialistic action.
 
May we recognize our real rights, and may we pick leadership to help us solve these problems and learn to more effectively pursue life, liberty and happiness.