Along with the Hippocratic oath, the MBBS curriculum has a mantra: bar God, all must provide data. A good physician treats patients based on scientific principles derived from solid evidence. The physician’s personal experience may embellish or temper these principles, but should not be ‘contrary’ to them.
In India, the mantra of scientific data and evidence is often not the basis of beliefs. The attraction of alternative, unscientific treatment methods has been irresistible. Aided by social media, ‘cure-mongers’, ‘quacks’ and ‘diet gurus’ issue medical diktats. Some are confused, and others believe them.
One hoax relates to chronic diseases such as diabetes. The lure of a complete cure is greater than boring, often predictable medical advice. In addition, the effort needed to sustain lifestyle changes often pushes people to ‘miracle remedies’ that free them from lifelong restrictions.
‘Claims’ on social media
Social media is flooded with claims that diabetes can be reversed or cured in hours or days. Through experiments we now know that remission is possible only in a small number of those with Type 2 diabetes, most of whom are obese and freshly detected; and that such remission will take months. And most diabetics cannot achieve remission. But the pull of a message offering cure is magnetic. People ignore advice from qualified doctors and flock to authors of these falsehoods.
One video tells us that if we consume ‘fruit juice’ diets or mangoes, we could control, even cure diabetes. This amounts to a con. Fruit juices are high on fructose or fruit sugar, which raises blood sugar levels. One patient with diabetes and kidney disease following such a diet without the doctor’s knowledge was brought in with not only high blood sugar but also high potassium levels. People with diabetes can take fruits in limited amounts, not more than two servings containing 15 gm of carbohydrates each.
Most of such messages are against national and international guidelines, and play to the gallery. These (‘eating saturated fat, for example, ghee, butter, in any amount will do no harm’; ‘there is no such thing as bad cholesterol’), are lapped up by the public because these give them freedom to eat what has been restricted by doctors. If one attempts any scientific criticism of the ‘experts’, one gets hounded in the social media. Other diet fads and harmful substances (blood group diet, gluten-free diet as panacea, bhasma (holy ash) and alternative medicines by gurus to cure asthma, tuberculosis and HIV) abound. All these result in selling food items or medication to unsuspecting patients, which brings lucrative gains to the perpetrator.
One galling news item from November 2016 states that insulin use in India is a scam, insinuating that doctors are unnecessarily prescribing insulin. Years ago, the landmark United Kingdom Prospective Diabetes Study showed that with the passage of time it is difficult to control diabetes with oral drugs alone, and insulin administration becomes unavoidable to halt serious organ damage. Delay in initiating insulin treatment (‘clinical inertia’ which can increase complications) is dangerous. Interestingly, less than five million people (6-7% of the diabetic population) currently use insulin in India, which is far less than that in the U.S. and the U.K., where the figures are 30-50%.
Another item says diagnostic criteria for diabetes (by blood sugar cut-offs) have been repeatedly lowered, and these are influenced by the pharma industry for profits, implying that more drugs will be used if more patients are diagnosed. This is a lie. The fasting glucose criteria for diabetes was arbitrarily set at 140 mg/dl about three decades ago. In 1997, after extensive review by experts (and not pharmaceutical companies) the fasting plasma glucose criteria for diagnosis of diabetes was revised downwards (from 140 mg/dl) to 126 mg/dl in a rigorously scientific manner. These criteria are based on the tendency of a large number of people with diabetes to develop complications (eye damage) after a particular threshold of blood sugar (in this case 126 mg/dl), based on a review of a large body of scientific data.
Not in all cases are perceptions and opinions of the public at fault. Sometimes confusing messages come from the scientific community. Maintaining glycosylated haemoglobin (HbA1c, used for monitoring blood sugar control and for diagnosis) value of less or equal 7% (meaning good blood sugar control) would decrease chances of complications. This cut-off point of HbA1c was based on data from large trials in the U.K. and the U.S., conducted over a decade. Recently, the American College of Physicians (ACP) said that maintaining HbA1c up to 8% (equivalent to average blood sugar value of 180 mg/dL) is fine. This statement has been vehemently and universally denounced, including by key Indian researchers (includes the authors). The distorted message now adds that blood sugar levels of 200-250 mg/dl are normal and only a value above 250 mg/dl is diagnostic of diabetes. Interestingly, the statement about increased limit of HbA1c by ACP was limited to control of diabetes, and not its diagnosis.
The medical fraternity should partly take the blame for not countering frauds and fake news. Most physicians/scientists are media-shy. Many of them can write good scientific papers, but not something that appeals to the masses. Their messages on audio-visual media are considered ‘boring’. Effective communication to the masses is never taught in medical schools. On the other hand, quacks, frauds and fake godmen (and even some retired, disgruntled physicians) deliver incorrect/fake statements effectively. One retired physician even has the audacity to tell people that the best thing to do if one has a heart attack is to stay at home and do nothing; if one goes to a hospital, one would surely die!
People listen. People applaud. People discuss and forward such messages. It is therefore essential that more medical leaders and medical associations, issue effective and clear messages countering such fake news.
A. Misra (Delhi), A. Mithal (Delhi) and V. Mohan (Chennai) are experts in diabetes and related diseases
The lure of a complete cure is greater than boring, often predictable medical advice