(Sort of an addendum to my last post)
With the shifting focus to official recognition that successful diabetes management lies in the hands of the patient rather than the medical provider, there's a whole lot of flurry of late about "behavioral issues."
Between moderating panel sessions at this weekend'sADA Conference, Dr. Polonsky was kind enough to give me a moment to ask himabout this phenomenon.
"So, diabetes is really unique this way, isn't it?Being the only disease that is managed more bythe patient than by the doctor?" I asked (thinking myself quite clever).
"No, actually, it isn't," he said. "What aboutcancer? And heart disease? Patients have to bediligent about testing their blood pressure, and about their diet --avoiding salt, for example. Actually, we'rebreaking ground here for other diseases by focusing on the behavioral side."
"Oh, I get it," I said (in another fit ofarticulation).
But I do get it! It's the old notion of"compliant" versus "non-compliant" patients turned inside-out. No matter what drugs and treatment plans areavailable, they will only work if the patienttakes charge and uses them proactively.
This simple fact has had an immeasurable effect oncountless clinical studies attempting to gaugethe success of medical therapies. For example, if you send a bunch of patients off with capsules they're supposed toswallow and a meal plan to follow, and thenmeasure their blood pressure levels (or whatever's being studied) weeks or months later, how do you really know anything forsure? Did they really follow instructions? Theymay say so, but everybody likes to get an "A," right?
On the flipside, patients involved in studies wherethey're closely monitored tend to overachieve forthe period while they're in the limelight. This well-documented occurrence is called the Hawthorne Effect
The point is (yes, I'm getting to it!) thatpatients aren't just abstract "subjects" at whichdoctors can throw new drugs and devices. Rather, they are the key people whowill make the medicine work. Likeso many "new" concepts in medical science, common sense is finally coming to the surface here: patients' behavior mattersat least as much as the treatmentsavailable!
(Anyone with brilliant ideas on how to motivatepeople to take better care of themselves cancontact Dr. Polonsky's institute here.Make sure to cc me at firstname.lastname@example.org as well!)