A Common Criticism

March 12, 2009

The big endocrine meetings are coming up: American Diabetes Association in New Orleans, and ENDO Society in Washington, DC.

The big endocrine meetings are coming up: American Diabetes Association in New Orleans, and ENDO Society in Washington, DC. Every year I, along with thousands of my colleagues, attend these meeting and come away inspired. Ah, breathe the word: inspired. How can you not be after being surrounded by smart people talking about all the interesting findings this past year and the even more interesting findings on the horizon?

However every time there is a fascinating study and wickedly positive findings, someone approaches the microphone in the middle of the aisle and asks the question to which we all know the answer: how replicable is this in real life? There are inevitable nods in the audience, some heads bowed and others shaking and wondering, “Don’t we all know the answer to this question already?”

It is a well accepted fact that studies involving human subjects at times, even observational studies, can be terribly skewed because of multiple factors including the very fact that they are being studied. We all want positive data, cold hard numbers that support an intervention or a medication towards achieving a worthwhile end. However the means to that end is not always easily duplicated in a real life non-study scenario (ie, the one in which we live and work everyday). The most common example of this in my endocrine world is every study in which “nutritional guidance” or “lifestyle intervention coaching” is mentioned. A few years ago when the large Diabetes Prevention Program trial was published there was a joint outcry of both hope and incredulity. Data supporting the notion that diet and exercise CAN AND DOES decrease progression to diabetes—great!!! Now the question how much “support” was used and how in the world we can get that incorporated into our word of managed care and 15 minute visits in clinic—grumble grumble, eye roll, sigh of despair.

Some of our best study data can have a Hollywood aura in that there were many supporting characters working very hard to bring you the scene that unfolds, effortless as it appears. But we know behind the scenes it was not effortless, and we wonder how this can be done without all the extra personnel. Diet and lifestyle intervention wins the prize for me as far as disillusionment with studies goes. On paper it was the most fabulous thing and here were countless news articles about this data. Just a few mentioned the herculean task that lay behind all that counseling and encouragement it took from study staff to get the participants to those wonderful goals. It was our version of the Biggest Loser, but the work was hidden behind the scenes and not made for TV. But then again, don’t we all feel like eating a bit better and exercising a few minutes more after watching the Biggest Loser? Admit it, you are among friends here.

Now back to our conference attendee standing in the aisle asking the question to which we all knew the answer. The speaker will invariably look at his/her feet then up at the crowd and answer something to this effect: true, the study incorporated an unusual amount of support staff that is not usually seen in standard clinic settings. But if we can achieve even part of the success of this study, it is worth a shot.

To that I heartily agree, and will be signing up for my conference attendance tonight. We all need a little inspiration, and we quietly thank our crew and staff for their support that make it all possible.