"The Emperor Wears a Thong"--More on Diabetes

I've referred many times to the myth that tight control of blood sugar levels in adult-type (type 2) diabetes confers any real patient benefit, despite the drumroll from advocacy groups and marketers to have patients checking their blood sugar with their monitors practically every 5 minutes. A very handy summary of the evidence we're here surveyed in a number of scattered posts can be found in:
http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2012.04057.x/abstract;jsessionid=EDB68E038FF876D039DFF928CE630DA1.d02t03

As the subtitle, "The Emperor Wears a Thong," suggests, the author is not willing just yet to say that the emperor of diabetes tight control wears no clothes at all--but I find it hard to read his article as really saying anything but this.

The article, by distinguished geriatrician Dr. Thomas Finucane from Johns Hopkins, focuses especially on the older patient--the group where the side effects of diabetes drugs are most likely to cause serious and even life-threatening problems. He reviews the various research studies that all fail to show any consistent reduction in important health outcomes when patients are subjected to efforts at lowering blood sugar aggressively.

Dr. Finucane pulls no punches as to where he thinks responsibility lies for our continued love affair with ever-lower blood sugar levels requiring ever-higher doses of drugs:

Worldwide, tremendous promotional efforts nourish the belief in “tight control,” and the market is huge. Every person with diabetes mellitus is a customer....

The timidity of performance-measurement initiatives, disease-focused charities, professional societies, and academics in confronting the discrepancy between the data and the public relations enterprise is a matter for serious consideration. A great deal of harm has been done to vulnerable elderly adults and others as a result of the public relations success with its echoing hue and cry. From a vendor's perspective, this is desirable.

In 1909, Sir William Osler said, “Far too large a section of the treatment of disease is today controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudoscience.” His remark may be more accurate now than it was a century ago.

Hat tip to Primary Care Medical Abstracts for the reference.