Our Drug Culture

Failure can tell you as much about yourself as the object of the lapse. Two large Type 2 diabetes trials were just presented at this year’s annual meeting of the American Diabetes Association.

Each began with a theory that was “obviously correct,” but somehow failed to give the expected answer based on what we think we know about how the body works.

The first was a National Institutes of Health project that was forced to halt early because the drug treatment caused the patients to die at an alarming rate.

The second study involved participants from 20 countries, and found that their drug treatment turned out to have no effect on preventing heart disease at all.

Each failure was surprising, given that the theory behind the research effort was so straightforward. Here’s the logic: a) when people with Type 2 diabetes die, heart disease is the culprit about two-thirds of the time; b) one of the hallmarks of diabetes is high blood sugar; ergo, if you lower the blood sugar, you might also expect to lower the risk of cardiac-related death.

This may make sense in principle, but in practice the results alternated between irrelevant (no effect) and harmful (actually increasing the death rate). That the body dynamic is more complicated that our hopeful theories is not remarkable. The truly interesting aspect of this particular hypothesis collapse is what it tells us about our culture of health.

For example, the media reported the science finding in headlines from the New York Times, “Tight Reign on Blood Sugar Yields No Heart Benefit”. When you read this, you think it’s only about the link between blood sugar and the heart. But, what actually happened, in both cases, was that drugs were given to diabetic patients to test whether they help reduce the incidence of heart disease. The pharmacology failed.

Nevertheless, when the diabetics in the treatment group of the first study were dying more frequently, no one suggested that the experimental medicine could be contributing to their deaths. Rather, it was reported that all those additional heart attacks were likely due to the rapid lowering of blood sugar. In other words, it’s the body’s fault.

The headlines did not say, “Diabetes Drugs Increase Death Rate.”

Likewise, when subjects in the most recent study saw no benefit in heart health from the medications, no one speculated that the drugs might be irrelevant. Rather, they puzzled over whether lower blood sugar may help the heart after all.

The headlines did not say, “Diabetes medication does nothing to help diabetes.”

These repeated omissions reveal one of our central medical assumptions: pharmacology is the solution. As such, it may reveal the problem with your body, but doesn’t contribute to it. This way of thinking is completely consistent with our scientific interpretations (and media reporting) of research results. Although we have rejected this conclusion in certain cases (if thousands of people end up in the hospital with heart valve problems [phen-fen] or we notice that antidepressants can induce suicides in our children), but these instances are rare and exceptional.

Seen from the outside, the logical sequence is inescapable: 1) our deference to drugs forms the core of our clinical approach to health; 2) this assumption creates the experiments and treatments we have today; 3) our treatments are failing to control soaring obesity, diabetes, and heart disease rates.

If we are to make a meaningful change in any of these chronic disease conditions, we must change the culture of health, beginning with our most basic assumptions.