I spend a lot of time highlighting the commercial forces that promote expensive medical interventions. So yesterday, when I read a lead author describe his new guidelines as “the most radical change in the treatment of type 2 diabetes for almost a century,” my first thought was, “why the hype?”
Francesco Rubino, who made this extraordinary claim in Nature, was describing not a new type of intervention, but a new consensus statement which argued we should be funding bariatric (weight-loss) surgery for more people, and at lower degrees of obesity. Yesterday’s Sydney Morning Herald article gives further background.
Now, we all agree that bariatric surgery has its place, but what are we to make of this statement which potentially expands that place from a niche into a town square?
First, we can dismiss the hype: a bunch of experts recommending surgery does not constitute a radical change in treatment, much less the biggest in a century.
The consensus statement was decided upon via a number of voting rounds, by a group of 48 people selected for their interest in bariatric surgery and diabetes.
Two of the 48 were Australians, both with a long publishing history highlighting the benefits of bariatric surgery. Clearly they and Rubino are experts in their field, but it’s also clear that, if you gather 48 such folk in a room, the inevitable recommendation is going to be more surgery, and more private and public funding to support it.
The guidelines have been endorsed by 45 medical and scientific societies, part of whose role is presumably to advocate for more funding for patients falling under their remit.
The health benefits and risks of surgery compared to other weight loss measures certainly warrant much debate and research. Surgery is expensive, potentially dangerous and doesn’t always work, but it is relatively effective in the real-world compared to many other weight loss approaches.
But whenever we read loud headlines, it also pays to be aware of the interests of those arguing for more of our health dollars.
More interesting to me would be a ‘budget-neutral’ debate.
Give the 48 group members, say, $100 billion to spend on diabetes treatment, and ask what proportion they’d allocate to bariatric surgery, knowing every surgical dollar would be subtracted from pharmaceutical spending.
Possibly the interest in bariatric surgery might still dominate, but given the number of pharmaceutical conflicts-of-interest declared by the 48, I’m not so sure.
Perhaps the ‘most radical change of the century’ might be watered down to just an ordinary old consensus statement after all.
Reblogged this on Dr Thinus' musings.
Indeed. Small sample of three people I know who have had this treatment – all put the weight back on over time. All were contantly unwell
One of Rubino’s self-referenced studies seems to suggest that glucose homeostasis is improved directly by the surgery itself rather than by any consequent weight loss. Rubino theorises that it’s the changes in gut anatomy that brings about the improvement.
It seems a bit dubious to me but, if true, what it would suggest is that there may be far less invasive methods of changing gut function to address diabetes than surgery.
Hey Dr. Justin,
I was on the hunt for weight-loss surgery treatment today and found this post on your website.
Thank you for this informative article. I will use some of its points to complete a new writing on my fitness blog.
Again, thank you for this article!