This is scientific research at its
poorest. When it comes to certain oral medications and their
comparison or companionship with insulin, researchers do not want to
expend the resources required or the time. The drug companies, of
course, will not admit that there is anything at fault with their
drugs and therefore will not help with any funding. And then we have
the self-anointed “experts” at the American Diabetes Association
and the American Association of Clinical Endocrinologists saying that
the oral medications are the first line of treatment for type 2
diabetes. When you examine the funds that the two associations
receive from Big Pharma, you will understand why they would say this.
And when people will make statements
like this, “In some cases, insulin is the only therapeutic
option remaining,” what does this tell us? Bold
is my emphasis. This has to mean that doctors have waited too long
to switch to insulin therapy and have forced patients to remain on
oral medications longer than should have been used. Not only have
doctors done harm to patients, they don't seem to care if they can
avoid prescribing insulin. This is why we need more research and
well funded research to identify people that have been kept on oral
medications too long.
We also need research to identify
problems researchers are loathe to do because they might learn
something that could prevent certain oral medications from being used
with insulin.
In this study, an epidemiologic
analyses, they are able to establish associations between medications
and outcomes, but they can never be completely positive that the
findings are unbiased. Even though many covariates were included,
such as the duration and glycemic control of diabetes, one factor is
fairly important, the risk of each individual outcome produced
similar results suggests 1 of 3 possibilities. These are that the
residual confounding remains, the outcomes are associated with each
other, or that they share the same causing event.
In this, the researchers blame insulin
and quote previous studies for what they lack in results and then
they do what is expected for a lackluster study and say that caution
is warranted and demand further study. This tells me that their
study was flawed to begin with and not well planned. Why they
received funding for these flawed studies still remains a mystery and
why the group or committee overseeing the funding allowed the study
needs investigation. Funds for studies will continue to be short in
the current economy, yet poorer and more faulty studies are being
funded.
As a side note,
it is interesting that metformin plus insulin went a long way to
lessening the increased risk found in insulin monotherapy. This may
be the impetus for continuing to add metformin when insulin therapy
becomes necessary.
In a recent blog here, I discussed
PCORI. PCORI is the Patient-Centered Outcomes Research Institute,
and is a new federal institute mandated to figure out how
meaningfully to involve patients in research. Under PCORI, patients
will have the rare opportunity to help make decisions about what
research is conducted, some of the design, and to be involved in the
research activity from the beginning. After all, isn't it the
patients with the disease that have the most at stake and the largest
to gain from research?
I also think there is much to be gained
from research conducted under PCORI. This may also open the door to
putting patients on some committees overseeing funding approvals at
academic centers that are currently mishandling research funds for
poorly constructed studies. I can envision patients with the disease
being placed on funding boards and in other capacities for oversight.
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