Reversing Type 2 diabetes? Yes, it can be done

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Increasingly, research is showing that Type 2 diabetes can be putinto long-term remission.

"It's taken years to accumulate this evidence," said Dr. Hertzel Gerstein, diabetes expert at McMaster University. "Ten years ago people would have been very skeptical that it's even possible."

Type 2 diabetes affects one in 10 Canadians. It is a serious metabolic disorder that can result in stroke, kidney failure, blindness, amputations and premature death. Right now doctors try to manage the disease using drugs to control a patient's blood glucose levels. Some of those drugs have serious side-effects.

"If you're on drugs it's not really remission, it's just controlling the disease," Gerstein said.

We reached him in Lisbon, where he's attending an international diabetes conference. At that meeting, a U.K. group presented research showing that Type 2 diabetes remission can be sustained for up to 10 years through weight loss.

Gerstein's own group is conducting a series of trials studying ways to reverse the condition using a combination of diet, exercise, counselling and short-term drug therapy.

Still, the goal of remission is not routinely being offered to patients right now.

"If you ask more experts at this meeting they'd say, 'Great idea,' but they'd have huge arguments about what to do and how to do it," Gerstein said. "The only way to resolve these arguments is to do the research."

Also this week, a group of U.K. researchers argued in the BMJ that doctors should be recording instances where the disease has been successfully reversed. And they say patients should be officially reclassified as "non-diabetic" when they achieve remission.

(Remission is defined as a return to normal blood sugar levels for one year without drugs.)

• New study questions Type 2 diabetes treatment

Gerstein cautions that remission won't always work for everybody. But he imagines a new era of diabetes treatment.

"I would love to look forward to an era where a large percentage of our patients who have been diagnosed with diabetes in the past are just being followed to make sure they're not relapsing, as opposed to lifelong drugs that are ever more complex, expensive and inconvenient."

How much does itcost to develop a drug?

Drugs are developed behind a curtain of corporate secrecy. But one group has been permitted to peek inside and see the data.

And for decades, thosecontroversial estimates from the Tufts University Centre for the Study of Drug Development have been cited to show how much industry spends to develop a new drug.

In 2003, it was $800 million US for a new pill. Today, the estimate has grown to $2.6 billion US.

But the Tufts researchers have never named the companies or the drugs they studied.

The black box of corporate confidentiality makes it impossible for independent researchers to check those numbers, butthe Tufts' estimate is often used to justify why new drug prices are so high.

So when two oncologists published an analysis this week setting the development costs for new cancer drugs at a fraction of the Tufts' estimate, it sparked controversy.

"I did not set out to create this ruckus," said Dr. Sham Mailankody from the Memorial Sloan Kettering Cancer Center. "I was surprised at how much attention it got, both positive and negative."

There's room here to lower cancer drug prices.- Dr. Sham Mailankody, study author

The new analysis used publicly reported data from 10 companies that developed new cancer drugs(including one non-cancer drug Soliris,dubbed "the world's most expensive drug.")

• How pharmaceutical company Alexion set the price of the world's most expensive drug

The conclusion: the median cost to develop a cancer drug is $648 million, about a quarter of the Tufts' estimate.

"There is room here to lower cancer drug prices, such that we continue to maintain reasonable margins for profits, but at the same time make these drugs widely available for patients," Mailankody said.

Canadian health economist Steve Morgan waded into the controversy by tweeting that the cost of research and development shouldn't dictate the final price.

"You don't pay firms for the cost of bringing something to market. You pay them for the value of what they brought to market," he told us.

At UBC, Morgan has studied drug development costs, and said most estimates don't include public investment, the millions of government dollars that subsidize new drugs through basic research and tax subsidies.

"It's a healthy debate," Morgan said. But he understands why the new analysis touched a nerve.

"Probably because this is getting close to the truth, and the truth may be dangerous for these firms that have used this narrative in the past."

More ghosts haunting the op-ed page

There were new questions this week about who's really writing op-ed commentaries in news publications. It's called "ghost writing" when an author signs a piece that was written by someone else whose name is not disclosed.

Last week in Second Opinion wetold you about one controversy,when it was revealed that a public relations company asked a neurologist to write a commentary for the respected health news site STAT. The opinion piece praised the role of pharmaceutical sales reps. It was later retracted after the doctor said there were inaccuracies in the piece, which he also said he didn't write.

• Retracted! How an op-ed piece praising drug sales reps backfired, raising issues of conflict of interestand ghostwriting in medical journalism

This week HealthNewsReview's Kevin Lomangino investigated the backstory behind another STAT op-ed piece written by a patient who credited drug company advertisements with saving her health.

The patient told Lomangino she was asked to write the piece by a PR firm working for a drug company that makes an expensive hepatitis C drug. After Lomangino published his story, STAT added a disclosure to the op-ed. And on Wednesday the editor of STAT announced the website has revised its op-ed policy.

It sounds like one of the attempts by the public relations industry to blur the line between news, comment and advertising.- Christopher Waddell, Carleton University journalism professor

The controversy has sparked a debate about the issue of ghost-written commentaries appearing in news publications.

"I don't know how common it is for PR outfits to do this," Ryerson journalism professor Ann Rauhala told us. "I fear all too common."

"The ghost writing definitely raises journalism ethics. At the very least, it violates the fundamental principle that the writing is your own work."

"It sounds like one of the attempts by the public relations industry to blur the line between news, comment and advertising, and they want to do that more and more," said Christopher Waddell, a journalism professor at Carleton University. "News organizations need to stand up and defend those differences."

How many health ministers does it take to ban trans fats? Now 6 and counting

The first health warnings came in the 1970s. By the 1990s, scientists had linked trans fat to heart disease.

But the ingredient is still not banned from processed foods in Canada, even though all of the political parties agreed on a ban almost 14 years ago.

Over the years various health ministers have announced incremental steps toward a ban. The most recent came yesterday, whennew Health MinisterGinette Petitpas Taylor announced that trans fats will be officially banned in a year, on Sept. 15, 2018, three months after a U.S. trans fat ban kicks in.

• Trans fats timeline

When it is finally in place, the ban on partially hydrogenated oils, the main source of trans fat, will apply to processed foods as well as restaurant and fast food.

This week obesity specialist Dr. Yoni Freedhoff revealed what he learned about trans fat in fries under the headline: "Canadians, Please step away from the chip wagons."

Dr. Martin goes to Washington, again

The first time Dr. Danielle Martin went to Washington she became an internet sensation. Close to 28 million people have watched her blistering response to a U.S. senator who criticized the Canadian health-care system during a U.S. Senate subcommittee hearing in 2014.

This week the Toronto family doctor was back in Washington, flashing her health card during a news conference as she described her experience having a baby in Canada without ever seeing a medical bill.

"There are certain things we take for granted, like that it doesn't cost anything to have a baby, that are actually unimaginable to Americans."

Martin was invited by U.S. Sen. Bernie Sanders to attend the launch of his "Medicare for All" bill aimed at creating a single-payer health-care system in the U.S.

"It felt like a historic moment," Martin said. While she was there she did a series of media interviews and recorded videos that Sanders and his team will be posting to answer very basic questions about how the single-payer system actually works in Canada.

To hear it characterized in the U.S., you would think Canadians are lined up down the street dying like flies. It's absurd.- Dr. Danielle Martin, family physician, Women's College Hospital

"There are lies that get propagated about Canadian health-care in the American public discourse," Martin said, including myths about government interference in personal health choices. And there's the recurring question about wait times.

"To hear it characterized in the U.S., you would think Canadians are lined up down the street dying like flies. It's absurd."

"I'm not going to say we don't have a problem with wait times in Canada," she said. "Although people are waiting too long for all kinds of things, at the same time we have very good outcomes from the care we get."

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