British doctor laments the pharmaceuticalised management of diabetes

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Des Spence is a UK general practitioner (family physician) who writes a weekly column in the British Medical Journal. Dr Spence does not shy away from pointing out what he feel is wrong with conventional medical practice. He regularly, it seems to me, has the independence of mind and balls to take a swipe at what we doctors do and the faults of the medical system.

In his latest column, Dr Spence turns his attention to the management of diabetes. This is a subject that is close to my heart, because I know only too well that this is a condition that so often responds well to the appropriate diet (in my opinion, that’s one low in carbohydrate). Yet, it is often the case that the dietary advice given to diabetics is woeful: diabetics are often encouraged to emphasise carbohydrate over fat, which almost inevitably ensures problems with blood sugar control and reliance on medication.

Dr Spence’s frustration is not centred on the dietary management of diabetes, but the pharmaceutical approaches to it. Specifically, he questions the wisdom of doctors increasingly using an increasing array of medications to lower blood sugar, when there is essentially no evidence that this actually translates into clinical benefits such as a reduced risk of heart disease or death.

Dr Spence goes on to write:

Worse, there is evidence that these new drugs cause harm. Rosiglitazone has already been withdrawn; pioglitazone has been linked to bladder cancer; and exenatide and sitagliptin double the risk of acute pancreatitis. All this is an example of the scientific illusion that is so called evidence based medicine, where research is just mechanically reclaimed statistics pulped into junk educational nuggets—mere marketing by another name.

Here’s what Dr Spence describes as the ‘drug industry’s business plan for diabetes…’

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1. Conduct questionable research and control the original data.

2. Schmooze the politicians, health regulators, and patient groups to suggest undertreatment and need for “urgent action.”

3. Recruit tame diabetologists, massage them with cash, and get them to present at marketing events that masquerade as postgraduate education.

4. Pay doctors to switch to newer drugs in dubious international postmarketing “trials.”

5. Seek endorsement from the National Institute for Health and Care Excellence to bully doctors to treat diabetes aggressively with drugs.


He ends with the following indictment:

The complicity of doctors and lack of dissent against the drug model of diabetes care is bad medicine.

It’s rare to read such candour in a medical journal, and I think Dr Spence is to be commended for, I think, saying it like it is. Personally, I think diabetics have been seriously let down by the medical profession. There is some light at the end of the tunnel, though: increasing numbers of diabetics are discovering for themselves just how effective low-carbohydrate eating usually is for controlling blood sugar and improving health markers.

Back in October, I wrote about a diabetic who had transformed his health through diet, but was admonished by his doctor when it was revealed that a ‘low-carb’ diet is what appeared to make the difference. This did not deter the diabetic though. And this is what I’m finding increasingly: individuals are less and less deferring to their doctor and more and more inclined to turn their back on what they see as out-of-date, unscientific and non-evidence-based advice.

I think we need more doctors like Dr Spence. Some may see him as a pesky whistleblower. I think the reality is that without doctors like him, the medical profession is just going to see a continuing erosion of its credibility.


1. Spence D. Bad medicine: the way we manage diabetes. BMJ 2013;346:f2695 [hr]

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