Pushing diabetics to take insulin is a medical scam: Fiona Godlee Is it true? Check your facts

Dr. Milind M Patil

Many advices circulate on social media especially health related ones. Most of them are written by non experts. Hence my general advice to patient is not to follow them. If anyone wants to know about disease I explain to them during consultation. If someone wants to read I suggest them either not to read or read from standard websites.
So I don’t react to social media health posts. But there are certain social media posts which needs to be answered.
Either they are from some doctors desk or they can mislead to masses and can be dangerous to the patients.

One such post is interview of Fionna Godlee the editor of BMJ one of the prestigious journal in science. The headline is “ Pushing diabetics to take insulin is a medical scam”. The interview was published in economic times in 2016. But recently it has appeared in social media.

What she had said about insulin is given below with the link.

people with diabetes in India are largely dependent on foreign-made insulin, which is expensive… There are certain things which are not going right. To put patients on insulin is a big push by industry and the doctors who in turn are influenced by the industry.

Rather than tackling the lifestyle issues, going straight to insulin is not the right option. That is a big worry because insulin is not without its harm and is expensive in India. I think it’s a medical scam, an industry scam. Patients think that this is the best drug for them, and they need to pay for it or else they would die, and a very big group of people are vulnerable to it.

I think we need to speak out against the pressure to put people on insulin. With diabetes becoming such an epidemic in India, we need to look at the root causes and put money there rather than putting people on insulin

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I was shocked to read this interview. Because it has irrelevant, baseless comments which are dangerous to the society.

1 Is it scam?
NO. I would have called it scam only if insulin is prescribed when it is not needed.
There are certain situations where we can’t use any other agent than insulin. E.g.
Type 1 diabetes, brittle diabetes, gestational diabetes not controlled on diet and metformin, patient with acute illness, hospitalised patients. To understand importance of insulin in type 1 diabetes please read about discovery of insulin.Before discovery of insulin the lifespan of type 1 diabetic was around few days to few months. Insulin has helped these type 1 diabetics to live more years.
Multiple studies have shown beneficial effects of insulin in gestational diabetes. In acutely ill hospitalised patients insulin is the most effective drug to control high glucose levels.
So pushing these type of diabetic patients for insulin is not scam but it is the evidence based medicine.

Someone may argue that pushing type 2 diabetics to insulin may be scam. Let’s see what happen in type 2 diabetes.
It’s progressive disease. Eventually these patient loose insulin synthesising capacity. By the five years nearly 50 percent type 2 diabetics require the insulin.So pushing these patients for insulin is not scam.

2 Instead of focusing lifestyle doctors focus on insulin.
The lifestyle modification has its own strength and limitations. So even after correcting lifestyle factors some patients don’t have good sugar control.Pushing these patients to insulin is not a scam. Every new patient and patient with poor glycemic control receive instructions for lifestyle modification. So no patient is directly pushed towards insulin.

3 Insulin is expensive. YES IT IS EXPENSIVE IN SHORT TERM. BUT THERE ARE CERTAIN OTHER MEDICINES WHICH ARE MORE COSTLIER THAN INSULIN. If we achieve good sugar control with insulin it will reduce the cost for complications. So long term cost will be less. There are basic insulin(regular, NPH) and high end insulin(various short acting and long acting analogues). Just like basic model vehicle also works basic insulin are efficacious. Just like high end vehicle offers many added features the analogs offer features like lower risk of Hypoglycemia, better flexibility with timings. So cost can be reduced by giving basic insulin instead of analogues. Further cost can be reduced by providing bio similar insulin and providing insulin through government hospital. For that government will need to spend more money on health sector.
So there are less costly ways to treat patient with insulin too.

4 Insulin is harmful. Insulin is the agent with the maximum sugar lowering potential. Apart from getting low sugar and weight gain there are no long term complications. If used judiciously it is one of the best medicine for diabetes.

5 There is pressure to push people on insulin.

Absolutely no. On the contrary there is inertia to start insulin from both patient side and from doctors side. Few of these factors are fear about insulin, time needed to understand use of insulin, lack of trust on doctor.

What are the consequences of such article?
What we are facing in India is deteriorating doctor patient relationship. Everyone is fit and healthy unless doctor/medicine create harm to them.This attitude is growing among general population at alarming rate. These kind of articles/ interviews work as fuel to spread such hatred . Patient refuses treatment when it is needed based on such articles.

What is the only thing correct in article?

The need to address the root cause. The root cause is our lifestyle. We need to adopt healthy lifestyle to reduce the burden of lifestyle related disorders…….
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