THE THREE
FIRST’S in DIABETES CARE,
21 YEARS BEFORE DCCT
“First to advocate and perform blood glucose self monitoring”
“First to use a blood glucose self monitoring and bolus/basal
insulin dosing to achieve tight control”
“First
to publish a paper on reversing complications by tight control”
Being the first for anything
in the medical field is not the easiest. As you will see,
it took a great commitment and a desire to help others to
achieve what Dr. Bernstein achieved.
We are proud to be friends
with Dick would like to thank him for providing us with the
materials to write this feature. We know you will find it
interesting and informative.
We have made it a 3-week series,
discussing the 3 first’s. Included is the actual article
on how tight control can prevent complications, that was finally
accepted by Diabetes Care and also the rejection letters from
NEJM, ADA, AMA and Lancet which stated that:
“No physician or patient
would ever be interested in such a time consuming program
of using a device to check blood glucose multiple times a
day and adjusting insulin doses”
Part 1 will be, “First
to advocate and perform blood glucose self monitoring”
Part 2 will be, “First to use a blood glucose self
monitoring and bolus/basal insulin dosing to achieve tight
control”
Part 3 will be, “First to publish a paper on reversing
complications by tight control”
If you have any comments, please
email us at publisher@diabetesincontrol.com
--------------------------------------------------------------------------------
PART 3
“First to publish
a paper on reversing complications by tight control”
I submitted the article and
its revisions to many medical journals over a period
of years — a period during which I was continually improving
in health, and continually proving to myself and my family,
if to no one else, that my methods were correct. The rejection
letters I received are testimony that people tend to ignore
the obvious if it conflicts with the orthodoxy of their early
training. Typical rejection letters read in part:
“Studies are not unanimous
in demonstrating a need for ‘fine control” (the
New England Journal of Medicine), or “How many patients
would use the electric device for measurement of glucose,
insulin, urine, etc.?” (Journal of the American Medical
Association). As a matter of fact, since 1980, when these
“electric devices” finally were made available
to patients, the worldwide market for blood glucose self-monitoring
supplies has come to exceed $3 billion annually. Look at the
array of blood glucose meters in any pharmacy, and you
can get an idea of just how many patients use, and will use,
the “electric device:’
Trying to cover several routes
simultaneously, I joined a few lay diabetes organizations,
in the hope of moving up through the ranks, where I could
meet physicians and researchers specializing in the disease.
This met with mediocre success. I attended conventions, worked
on committees, and met many diabetologists. In this country,
I met only three physicians who were willing to offer their
patients the opportunity to put these new methods to the test.
Meanwhile, Charlie Suther was
traveling around the country to university research centers
with copies of my unpublished article, which by now had been
typeset and privately printed at my expense. The rejection
by doctors of the concept of blood sugar self-monitoring,
even though essential to blood sugar control, was so intense,
however, that the management of his company had to turn down
the idea of making meters available to patients until many
years later. His company and others could clearly have profited
from the sale of blood glucose meters and test strips. However,
the backlash from the medical establishment prevented it on
a number of counts. It was unthinkable that patients be allowed
to “doctor” themselves. They knew nothing of medicine
— and if they could, how would doctors earn a living?
In those days, patients visited their doctors once a month
to “get a blood sugar:’ If they could do it at
home for 25 cents (in those days), why pay a physician? But
almost no one believed there was any value to normal
blood sugars anyway. In some respects, blood glucose
self-monitoring remains a serious threat to the incomes of
many physicians who specialize in the treatment of the
symptoms of diabetes and not the disease. Drop into your neighborhood
ophthalmologist’s office and you will find the waiting
room three-quarters filled with diabetics, many of whom are
waiting for expensive fluorescein angiography or laser treatment.
With Suther’s backing
in the form of free supplies, by 1977 I was able to get the
first of two university-sponsored studies started in the New
York City area. These both succeeded in reversing early complications
in diabetic patients. As a result of our successes, the two
universities separately sponsored the world’s first
two symposia on blood glucose self-monitoring. By this time
I was being invited to speak at international diabetes conferences,
but rarely at meetings in the United States. Curiously,
more physicians outside the United States seemed interested
in controlling blood sugar than did their American colleagues.
Some of the earliest converts to blood glucose self-monitoring
were from Israel and England.
By 1978, perhaps as a result
of Charlie Suther’s efforts, a few additional American
investigators were trying our regimen or variations of it.
Finally, in 1980, manufacturers began to release blood glucose
meters for use by patients.
This “progress”
was entirely too slow for my liking. I knew that while the
medical establishment was dallying there were diabetics dying
whose lives could have been saved. I knew also that there
were millions of diabetics whose quality of life could be
vastly improved, so in 1977, I decided to give up my job and
become a physician — I couldn’t beat ‘em,
so I had to join ‘em. This way, with an M.D. after my
name, my writings might be published, and I could pass on
what I had learned about controlling blood sugar.
After a year of premed courses
and another year of waiting, I entered the Albert Einstein
College of Medicine in 1979. I was forty-five years old. During
my first year of medical school I wrote my first book, Diabetes:
The Glucograf Method for Normalizing Blood Sugar, enumerating
the full details of my treatment for Type I, or insulin-dependent,
diabetes.
In 1983 I finally opened my
own medical practice. By that time, I had well outlived the
life expectancy of an “ordinary” Type I diabetic.
Now, by sharing my simple observations, I was convinced I
was in a position to help both Type I and Type II diabetics
who still had the best years of their lives ahead of them.
I could help others take control of their diabetes as
I had mine, and live long, healthy, fruitful lives.
Recently for this anniversary
issue, I asked Dr. Bernstein for his recollection regarding
the acceptance of his article “Virtually Continuous
Euglycemia……
May 8, 2002
Dear Steve
One of these letters is from
DIABETES HEALTH CARE, which was the working title for DIABETES
CARE prior to initial publication, the ultimate publication
of “Virtually Continuous Eug1ycemia.” …..in
the journal DIABETES CARE, occurred in 1980 via a flukey set
of circumstances. In 1978, Sheldon Bleicher M.D. and I began
a research project using his Patients and my blood sugar control
methods in an attempt to reverse early retinal leakage in
diabetics by normalizing blood sugars. We were indeed able
to demonstrate the successful accomplishment of our goal.
The Ames Division of Miles
Laboratories had provided us with the 3’ lb. blood sugar
meters that I describe in my book and blood sugar test strips,
all gratis. Because of the favorable, outcome of the study,
Ames sponsored a symposium on blood sugar self monitoring
under the auspices of Dr. Bleicher and the New York Downstate
University. A select group of diabetologists from around the
country was invited to attend. Since my agreement with Dr
Bleicher was that my name would be cited in any publications
and I would be allowed to present the methodology to any symposia,
I was allowed to present this paper at the meeting. The firm
that was responsible for Ames publicity negotiated an arrangement
with Jay Skyler, editor of DIABETES CARES to publish all of
the papers presented at the symposium. Since I had read this
paper at the symposium, it was automatically published even
though it had been rejected in 1971.
It is worth noting that the
ADA continued to reject blood sugar self-monitoring as a viable
methodology until a joint meeting with the American Association
of Diabetes Educators in 1986. At that time, self-monitoring
was approved, only for insulin users, thereby keeping out
90% of diagnosed diabetics.
Richard K. Bernstein, M.D.,
F.A.C.N., F.A.C.E.
Rejection
Letters:
Part 1:First
to advocate and perform blood glucose self monitoring
Part 2:“First
to use a blood glucose self monitoring and bolus/basal insulin
dosing to achieve tight control”
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