Angry Doctor

Tuesday, November 29, 2005

Sweet Deal?

OK, a bit of medical education today, prompted by this letter from the ST Forum:

Nov 29, 2005
Detect diabetes with free screening

IN THE report, 'Not-so-sweet truths about diabetes' (ST, Nov 24), it was stated that 160,000 people here do not know that they have diabetes because they have never checked. About one in 10 adults here has the disease, double the world average.

Before we look into the problem, we need to know why these people do not go for medical check-ups. Is it because some of them cannot afford the cost of the tests?

Early this year I was fortunate to get a free medical check-up - for blood pressure, cholesterol level, blood sugar, etc - near Jurong East MRT station. But that was the only free screening this year. Such screening should be held more frequently, and publicised at all MRT and bus stations.

Sng Ah Beng


Fact, however, is that screening for diabetes in the general population is not cost-effective, and does not give better outcome for the persons screened.

So why are there organisations doing 'free' screening? Well, because just because it’s 'free' to you, doesn’t mean there’s no money involved…

Labels:

58 Comments:

  • Hmm I dun think the man on the street would care about such studies. Common sense also says that if there is no difference between knowing I have diabetes and not knowing I have diabetes then what the hell?

    Anyway if customer want, we should give lah hor? Even if customer dun pay. That is the ULTIMATE in customer service don't you think?

    PS : this letter you ownself write one right? Can tell from the name you choose. "Sng Ah Beng" wah lau pain gangster..yeah right. Nice try angry doc but you can't fool me!

    By Anonymous Dr Oz bloke, At November 29, 2005 3:30 pm  

  • eh, nice drama mama photo on your blog header.

    Anyway, the big reason why such 'free' screening are done is ADVERTISING. Nobody admits it publicly but it's a chance to 'catch' people who are at risk of any such conditions, then offer them products and services.

    The last time my friend went for such a screening, he was told that he was at risk from a barrage of illnesses, ranging from detached retina to diabetes and heart disease. Subsequently given brochures of health products and information on health services available. The staff even offered to help my friend book at an appointment, non-subsidzied class, of course.

    Ok enough rant for today.

    By Blogger andrew, At November 29, 2005 3:32 pm  

  • but...but.....

    it's for a good cause mah. We really do care about the health of our people you know....

    By Anonymous Dr Oz bloke, At November 29, 2005 3:40 pm  

  • Capitalism can pervert any noble cause we can think of. Charity, religion, healthcare... as long as there is money to be made from something, people will try to make money out of it.

    By Blogger angry doc, At November 29, 2005 5:58 pm  

  • Hmmmm a bit off topic....

    So do you think capitalism coaxes the "evil" out of men?

    Perhaps we should keep certain things socialist eh? Like health care?

    By Anonymous Dr Oz bloke, At November 29, 2005 6:20 pm  

  • "Common sense also says that if there is no difference between knowing I have diabetes and not knowing I have diabetes then what the hell?"

    That is actually quite insightful. I think we need to realise that DM is in the vast majority of patients NOT a silent disease, like say hypertension.

    But that doesn't really gel with the concept that insulin resistance and frank DM is a continuum... or that cellular damage occurs way before diagnosis... any idea?

    By Blogger angry doc, At November 29, 2005 6:31 pm  

  • The common pitfall with socialism and capitalism is that for good to come out of the system, the people involved must themselves be 'good'.

    I'm not even sure we can agree on what good is...

    By Blogger angry doc, At November 29, 2005 6:34 pm  

  • My personal belief as far as diabetes is concerned is that it is an imbalance of various multiple factors.

    Insulin resistance due to receptor defects or damage, with possible increased baseline insulin production, possible imbalance between insulin and glucagon, imbalance between intake of refined high glycemic index sugars causing sharp rises in plasma glucose thus contributing to the imbalance again.

    Should we check patients earlier? I think so. I personally believe that if we can detect that a patient has got say impaired glucose tolerance at an early age, we can give them counselling regarding nutrition (eg Glycemic index and carbohydrate control)

    With early changes in their diet and nutrition, I am quite certain we can reduce long term morbidity and mortality. So far a lot of studies are like this. Screen. Then start some form of medication.

    Diabetes is NOT best treated with medication at early stages. The problem for many doctors is that if they don't give medicine, they do essentially NOTHING.

    I've seen patients going to Heart centre and told they are borderline this and borderline that. And they are so happy they didn't have to take medication. So I asked them, what did the doctor tell you to do then? And they said nothing, jsut come back in 6 months and check again. I told him, they are just waiting for you to no longer be "borderline" so they can start you on drugs. You think doing nothing will give you better chances of improving in 6 months?

    That's the problem.

    By Anonymous Dr Oz bloke, At November 29, 2005 6:46 pm  

  • But if you are going to tell the guy to keep healthy anyway, why bother checking when he is asymptomatic?

    I mean, you are not going to say:'Wah, LDL lower than HDL - can eat what you want!', right?

    Or: 'Wah, fasting glucose lower than your IQ, can drink kopi-peng all you want, man.'

    Are are you? :)

    By Blogger angry doc, At November 29, 2005 6:50 pm  

  • some organizations do it for branding, for community outreach?? not just for selling of products.

    By Anonymous Anonymous, At November 29, 2005 6:54 pm  

  • Well that's the thing you see. Majority of tests in common "screening" packages are actually useless from a preventive medicine point of view,in my opinion.

    Firstly most of the tests are designed to pick up an established disease in someone. So as you rightfully say, majority of the asymptomatic would have all normal results. I mean that's the case isn't it? Is it a waste of money? I think so. If there are abnormalities what happens usually? Patients go on medicine.

    Now my view of "prevention" is more of a primary prevention sort of ideal. Can we do something to prevent the diseases? Can we get warning bells from tests that can indicate higher risks of getting certain diseases?

    This field is undergoing a lot of controversy. But controversy does not exactly mean that it is wrong and it has no place.

    One interesting test is fasting insulin levels and fasting glucagon levels. The ratio of these two at fasting samples may give us some clue about glucose metabolism and possible "insulin resistance" or is it "glucagon sensitivity"?

    One thing is for sure I have seen people with fasting insulin levels of 5 and some of 30! And this is fasting samples. 6 fold differences.

    Anyway this is controversial. I talked to some MOH people before. If they were to comment anything on screening tests, it automatically implies that everyone has a basic right to access of these tests. At the moment the budget vs benefit analysis is not in favour of primary preventive medicine or screening tests.

    But it is an area of interest on my part.

    By Anonymous Dr Oz bloke, At November 29, 2005 7:00 pm  

  • My interest is on how medicine as a science translates to a social phenomenon, especially in the arena of public or subsidised healthcare. But I enjoy clinical medicine too much to go into public health full-time.

    By Blogger angry doc, At November 29, 2005 7:04 pm  

  • "some organizations do it for branding, for community outreach?? not just for selling of products."

    Then you need to ask yourself why they are promoting their 'brand' and why they are reaching out.

    Peanuts, anyone?

    By Blogger angry doc, At November 29, 2005 7:05 pm  

  • Just two quick articles about hypersinulinemia and homocysteine. These test are available and they can be modulated with dietary factors.

    http://content.nejm.org/cgi/content/abstract/334/15/952

    http://content.nejm.org/cgi/content/abstract/337/4/230#related_letters

    By Anonymous Dr Oz bloke, At November 29, 2005 7:14 pm  

  • Sounds depressing.

    That kind of information seems to be useful only for insurance companies.

    By Blogger angry doc, At November 29, 2005 7:37 pm  

  • Why does it sound depressing?

    Those tests can be improved with dietary factors. They are not death sentences.

    By Anonymous Dr Oz bloke, At November 29, 2005 7:40 pm  

  • Independent risk factors which you cannot change are always depressing to me. It's like a bad hand in poker.

    But then:

    " ev'ry hand's a winner
    and ev'ry hand's a loser

    And the best that you can hope for
    is to die in your sleep."

    By Blogger angry doc, At November 29, 2005 7:45 pm  

  • well if you choose to insist that they are risk factors you cannot change then that's just too bad.

    http://content.nejm.org/cgi/content/abstract/340/19/1449

    By Anonymous Dr Oz bloke, At November 29, 2005 7:52 pm  

  • Can you change your fasting insulin level?

    By Blogger angry doc, At November 29, 2005 8:00 pm  

  • This comment has been removed by a blog administrator.

    By Blogger Corporate Manwhore, At November 29, 2005 8:14 pm  

  • Of course you can.

    What raises insulin levels?

    We've found that patients who go onto low glycemic index carbohydrate type of diets can lower their fasting insulin levels.

    I think Dr Warren Lee's group has been doing some studies involving fasting insulin levels and they recently made that announcement that Type II diabetes is curable with weight loss in children.

    There is an interesting compound called corosolic acid that lowers blood glucose levels.

    Still a lot of research going on. But I'd say taking a low GI carbo diet is the best way to lower fasting insulin levels.

    By Anonymous Dr Oz bloke, At November 29, 2005 8:17 pm  

  • Oz Bloke,

    Oh. That changes everything then. :)

    I thought the fasting level was some sort of basal level that you can't change.

    By Blogger angry doc, At November 29, 2005 8:22 pm  

  • Nope it sure can be changed. But they aren't changed with drugs.

    That's the thing with western medicine. It's too pharmaceutically driven I feel.

    For eg a very good lipid lowering agent is Niacin. It is damn cheap, lowers TG, lowers LDL. But it is hardly promoted. Why?

    By Anonymous Dr Oz bloke, At November 29, 2005 8:25 pm  

  • Sorry, Deuce, angry doc doesn't want to reveal his identity.

    I could go anonymous or as 'angry doc', but I guess that defeats the purpose of an opinion. :)

    By Blogger angry doc, At November 29, 2005 8:26 pm  

  • Er... flushing?

    By Blogger angry doc, At November 29, 2005 8:27 pm  

  • Yes flushing is a common side effect. But it usually resolves after time.

    Also taking aspirin 325mg 30 min before taking niacin can reduce the flushing effect.

    There are also extended release formulations too. Dun forget niacin also raises HDL!

    By Anonymous Dr Oz bloke, At November 29, 2005 8:33 pm  

  • Okay, too bad then.

    Have a nice day.

    Cheers,
    Corporate Manwhore

    By Blogger Corporate Manwhore, At November 29, 2005 8:34 pm  

  • Personally I think this aspect of healthcare needs more attention than what's given now. I mean preventive medicine.
    The main problem I see in the lay public's mentality is "do nothing til there's a problem" or "if it ain't broke, don't fix it." That is the main hurdle all of us have to overcome.
    With the advent of modern civilization we as consumers are faced with more convenience but find it increasingly difficult to maintain health through daily activities. For example, who eats unpolished rice nowadays? It's cheaper to buy polished rice now. Who has the time to cook and eat proper balanced diet when all we have are 15 min lunch break for that plate of char siew rice? Why climb a single flight of stairs when there's an escalator nearby (the one that takes the cake is the really short escalator at the entrances of Funan Centre)?
    Modern living = convenience at a health cost? I certainly think so.
    It takes a lot more conscious effort to keep healthy in this society.

    And the ironic thing is that junior docs put in, what, 90 hours a week to ensure the health of patients but at what cost to their own health? I believe people in other professions suffer from the same "no time" malady.

    Thank goodness I got out before it killed me...

    By Blogger andrew, At November 29, 2005 9:50 pm  

  • I think it's a matter of perspective. I don't think it really takes that much effort to pick something healthy to eat at the hawker centre. In fact, the veges at the rice stalls tend to be slightly undercooked (to maintain an attractive colour), which is what Singaporeans need to do, really.

    And don't let other people tell you how much to eat or drink. You don't NEED to finish all the rice on your plate, or drink up all the coffee. You are no longer a kid!

    As for taking the lift or elevator instead of stairs? For anything less than 5 floors, it's probably faster to take the stairs. If you find that it's not, you either have a very efficient lift system, or are so unfit you really NEED to start using the stairs.

    Exercise in the evening? Just skip 30 minutes of TV and that's enough time to work up a sweat.

    By Blogger angry doc, At November 29, 2005 10:08 pm  

  • If only people are willing to put in effort to do all that preventive measures, most common health problems would be solved.

    Instead they want to 'enjoy life' and otherwise 'life' would be meaningless...

    Or that they rather sacrifice their health for the sake of money ..

    By Anonymous dryvlee, At November 30, 2005 12:19 am  

  • "For eg a very good lipid lowering agent is Niacin. It is damn cheap, lowers TG, lowers LDL. But it is hardly promoted. Why?"

    Because of certain incovenient side effects?

    By Anonymous Anonymous, At November 30, 2005 1:47 am  

  • BTW is niaspan doing well in aust?

    By Anonymous Anonymous, At November 30, 2005 1:49 am  

  • I read an interesting commentary in the TODAY

    http://www.todayonline.com/articles/87368.asp

    Clearly Singapore's "experts" have no clue as to what nutrition is about if they are still saying "Margarine is preferred to butter" and "choose unsaturated margarine.."

    I wonder whether the majority of doctors in Singapore know the differences between "polyunsaturated omega 3 essential fats margarine","monounsaturated olive oil omega 9 margarine" and "butter". Which would you choose? And why?

    By Anonymous Dr Oz bloke, At November 30, 2005 9:17 am  

  • The comments and recommendations featured on that Today article was embarassing for the organizations involved. I wonder if some heads are going to roll.

    Anyway, I totally agree that some people (in fact, most that I've counselled) can't be bothered to put in the effort to maintain health. I mean, they rather pay someone to cling wrap their tummies in the hopes of losing the inches. It's ridiculous. Lose weight by lying down on a bed like a mummy?

    Someone once told me this story about a conversation between a foreign diplomat and a Chinese mandarin nearing the end of the Ching dynasty:

    The diplomat was playing tennis when the mandarin came to visit him. Being a good diplomat, he invited the mandarin to join him for a game. Looking at the sweaty diplomat, the mandarin replied, "Why do you have to sweat? Get your servants to do this instead!"

    By Blogger andrew, At November 30, 2005 10:12 am  

  • read that.

    had no idea i was consuming so much trans fat in all the bread, cakes, cookies that i like to eat.

    gasps.

    By Blogger 幸せな女の子 :), At November 30, 2005 10:16 am  

  • I believe we have all been brain-washed into thinking that we need to smear oil on our bread before we eat them.

    By Blogger angry doc, At November 30, 2005 10:17 am  

  • U definitely feel much better after a sweaty game of tennis :)
    But I also enjoy papmering my body to those relaxing Spa treats :)
    It's all about having a Balanced Lifestyle ;-)

    By Anonymous Anonymous, At November 30, 2005 10:19 am  

  • I'd Choose BUTTER anytime... do u know what the yummy croissant is made of?

    By Anonymous Anonymous, At November 30, 2005 10:31 am  

  • Yeah but WHY butter and not margarine?

    You see there are a lot of misconceptions about all the oils. Some would say this oil is good and that oil is bad but what they are really doing is revealing what they want you to hear and omiting what they don't want you to hear. I've seen it happen all the time. This book wants to sell coconut oil, they tell you all the good stuff until you think it is absolutely good with no bad effects. That isn't true.

    Same with olive oil. Yes olive oil.

    I usually spend 15 minutes with interested patients and friends telling them the benefits and problems of monounsaturated oil, omega 6 polyunsaturated oil, omega 3 polyunsaturated oil, medium chain triglycerides, and saturated fats. I lay the facts and they go home with the handwritten diagram I draw.

    As medical professionals, it is our duty to educate and give the facts unbiased. And then the patients can decide which oils they want to take and how much they want to take.

    By Anonymous Dr Oz bloke, At November 30, 2005 10:48 am  

  • After reading articles about fats and oils in the “mind your body”, I realize they aren’t telling you everything..

    Fats don’t just affect cholesterol levels. They do much more than that.

    Essential fatty acids like Omega 6 and Omega 3 fatty acids are used to produce eicosanoids. These are important intercellular messengers that control among other things inflammation and hemostasis. Remember the prostaglandins? Or thromboxane?

    Ever wondered why olive oil and corn oil tends to come in tinted bottles and have warnings on them saying “Keep in cool and dark places”? Well if you expose unsaturated fats to heat and light, they can turn rancid and form free radicals. Doesn’t that ring a bell? Cancer anyone?

    By Anonymous Dr Oz bloke, At November 30, 2005 10:58 am  

  • dr oz bloke, can draw out for me? :)

    By Blogger 幸せな女の子 :), At November 30, 2005 11:00 am  

  • I tell you what I'll do a write up and post it on my blog

    By Anonymous Dr Oz bloke, At November 30, 2005 11:11 am  

  • hmm and wat is ur blog url?

    By Blogger 幸せな女の子 :), At November 30, 2005 11:13 am  

  • I'll take some time writing this since I reckon the readers might be doctors as well.

    I'll put it up as soon as I can.

    My blog is www.drozbloke.blogspot.com

    By Anonymous Dr Oz bloke, At November 30, 2005 11:16 am  

  • sheesh i better bake less often now and cut down on my cakes and cookies intake :(

    and how about chocolates huh??

    By Blogger 幸せな女の子 :), At November 30, 2005 11:18 am  

  • BUTTER coz i'm a pro-dairy person... not particularly concerned with excessive fat levels as i keep to balanced diet :P

    Dr Oz Bloke done wif your drawing yet? :)

    By Anonymous Anonymous, At November 30, 2005 11:19 am  

  • hmm new blog? only got 1 entry wor. anyway, take ur time no hurry...what's important is the information must be accurate :)

    By Blogger 幸せな女の子 :), At November 30, 2005 11:26 am  

  • As it is a blog, and I am not that good with computers, I'm doing a write up instead

    It is getting a bit long though....

    By Anonymous Dr Oz bloke, At November 30, 2005 11:42 am  

  • no worries :)

    By Blogger 幸せな女の子 :), At November 30, 2005 11:51 am  

  • Dear Dr Oz

    Great you have a blog now. I will visit it daily for sure.

    Will also be waiting for your write up on fats.

    By Anonymous Anonymous, At November 30, 2005 1:20 pm  

  • ok I've posted the write up on fats in my blog.

    Feel free to comment, ask questions, dispute, challenge or whatever :)

    By Anonymous Dr Oz bloke, At November 30, 2005 1:27 pm  

  • Ah, you finally gave in to temptation. couldn't resist Eve's apple huh.

    "Feel free to comment, ask questions, dispute, challenge or whatever :)

    Really? Then why the censorship where you have to approve comments huh? At least Dr. Angry is more liberal and "wu lan pah"

    Congrats on your Blog opening though.

    The lion dance troupe will be around soon.

    By Blogger uglybaldie, At November 30, 2005 2:19 pm  

  • oops I think that was unintended!

    I'll go correct it now!

    No wonder I was wondering why no comments leh!

    By Anonymous Dr Oz bloke, At November 30, 2005 2:31 pm  

  • at least uglybaldie gets to read... i can't even read the article... thot it's written in invisible ink.. :P

    By Anonymous Anonymous, At November 30, 2005 2:46 pm  

  • Ok, looks like you are Australian after all.

    While you are tweaking your blogsite, I am taking my afternoon nap.

    Good on ya, Doc.

    By Blogger uglybaldie, At November 30, 2005 2:47 pm  

  • Er....Doc, I am awake from my siesta and waiting to feista.

    What happened? Lost the keys to the vault?

    Like I said, good posts but let's have some contentious issues. All those mumbo jumbo about fats and vitamins we can get from thousands of site on the net.

    Say something naughty ok?

    By Blogger uglybaldie, At November 30, 2005 6:02 pm  

  • there is one company promoting Niacin now.

    By Anonymous Anonymous, At November 30, 2005 7:40 pm  

  • Dear uglybaldie,

    and what get charged for sedition?

    Dowan lah.

    By Anonymous Dr Oz bloke, At December 01, 2005 9:07 am  

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