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Public Policy and the Diabetes Epidemic

By Bill Zeeble, KERA 90.1 reporter

Dallas TX – Bill Zeeble , KERA 90.1 reporter: Lobbyists and others who try to squeeze money out of the government to fight the so-called ?good fights? - against hunger or deadly diseases - admit the system can be tough.

Mike Mawby, Vice President of Government Relations, American Diabetes Association: It?s inherently resistant to efforts to establish priorities, with a few glaring exceptions, like the AIDS and breast cancer communities, which have done tremendous jobs of organizing their support in Congress.

Zeeble: Mike Mawby is the national Vice President for Government Relations with the American Diabetes Association, the ADA.

Mawby: But for most policy makers, they view it as zero-sum game, and if someone promotes diabetes, it means taking money from cancer or Alzheimers or something else. So there?s a real tendency to do something in an across-the-board fashion.

Zeeble: Diabetes kills more people than breast cancer and AIDS combined every year, according to the ADA. The disease takes years off one?s life, just like Alzheimers; it just usually takes longer, and often costs more money. Yet Mike Mawby says it?s not as sexy as high-profile diseases he admits deserve funding too. He wants a minimum funding floor for serious diseases, but argues diabetes needs more money for prevention, research and education, because he says the costs of this illness will eventually dwarf the costs of others.

Mawby: If you take the NIH perspective - which is to lay out a set of criteria that in total help determine the impact of a given disease on society, and they have a set of objective criteria - when you look at that, diabetes ends up at or near the top of all of them.

Zeeble: Mawby routinely tries to make that case, and routinely hears this kind of response from well-meaning, and pressured, Congressional leaders like Representative Ralph Regula of Ohio.

Ralph Regula, incoming Chair, Congressional Labor, Health and Human Services, and Education Appropriations Subcommittee: Any research will be supported as much as possible, depending on constraints of the budget.

Zeeble: Regula is the incoming Chairman of the subcommittee on Labor, Health and Human Services, and Education Appropriations. That subcommittee, in part, funds diabetes research at the National Institutes of Health.

Regula: I?m particularly aware of the problem of diabetes, but there are many different problems and challenges in the medical field. I?m a strong believer in research and will, as much as possible, support these programs.

Zeeble: Congress has allocated 240 million dollars for diabetes research and education over the next three years, but the wish list (from advocates) is six times that over the next two years. So Mawby and physicians like Ron Goldberg call their list a dream. But they maintain some sort of federal policy is still necessary to spread the word about the most serious predictors of diabetes - obesity and sedentary behavior. Dr. Goldberg, based at the University of Miami, is the principal investigator of the National Diabetes Prevention Program.

Ron Goldberg, MD, Professor of Medicine, University of Miami (Florida) and Principal Investigator, Diabetes Prevention Program: The key will be a national program with development resources. To just say, ?lose weight? will probably not have an effect.

Zeeble: Doctors have been saying that for years, but the most recent government estimate now indicates 60% of the U.S. population is obese. What?s more, a Yankelovich poll shows only about 40% of adults think they?re overweight. Even though obesity is the key factor behind an alarming rise in diabetes over the last decade, most of those surveyed have never discussed diabetes with their doctors. Goldberg says it?s time for a change.

Goldberg: Much as we?ve done for cholesterol, heart disease, blood pressure, stroke. There?ll have to be some program at the national level that promotes the idea not just that weight reduction is good for you or activity is good for you, but that you can prevent diabetes with it.

Zeeble: Goldberg says when he?s talking diabetes prevention, he really means preventing heart attacks or strokes. 25% of heart disease patients have diabetes, he says, and heart disease is the nation?s number one killer. One of Goldberg?s colleagues at the University of Miami, Dr. Alan Delamater, is especially worried about obesity-related diabetes among children. The researcher and psychologist in the University?s pediatrics department says children never used to get Type-2, or non-insulin dependent, diabetes. Now that they are, they can expect deadly complications by middle age, or sooner.

Dr. Alan Delamater, Director of Psychology, Department of Pediatrics, University of Miami (Florida): School lunch programs aren?t very healthy for kids, in most cases. They don?t provide healthy alternative, but fatty foods, which are amply provided. After- school programming for kids, we think, in fact is a real opportunity for kids to become more active in organized settings like that. There is definitely a need for public policy.

Zeeble: The government recently reported school lunch programs are only slightly healthier than they were a decade ago. As for physical activity in schools, computers are an ever-increasing educational tool which can lead to sedentary behavior. Yet any school changes, which sound simple, are made complex because of the number of children and school districts across the country. So diabetes organizations like the American Diabetes Association aren?t even pushing for a national policy to deal with obesity or inactivity for children or adults. Instead, the ADA is seeking money for outreach programs at community health clinics. Many of their patients are minorities, who have a higher frequency of diabetes and its complications. In addition, the ADA?s Mike Mawby plans to spend time with new congressional leaders like Representative Regula.

Mawby: And to the extent that the old players weren?t necessarily providing the kind of funding for diabetes research and programs that the ADA thought it warranted, it?s a new beginning in that sense. I mean, it?s a fresh start.

Zeeble: Mawby and endocrinologists who deal directly with this ailment every day say the increasing number of diabetics and those with its complications will not go away. He warns the illness must be viewed as a public health issue, not just a disease, because the social and economic impact could be overwhelming if something?s not done soon to address the epidemic. For KERA 90.1 I?m Bill Zeeble.