Pay It Forward and a Modest Proposal

Diabetes cost: too high to ignore?

By A.Paul Chous, MA, OD, FAAO
Tacoma, WA

The Centers For Disease Control (CDC) estimates that both the number of cases of diabetic retinopathy and the number of Americans who will become blind as a result of diabetes-related eye complications will double by the year 2050. That's a truly staggering statistic, especially since currently eye complications from diabetes cost our economy more than $500 million annually. The tragic irony is, of course, that most cases of blindness caused by diabetes are totally preventable with a three-pronged approach:

1.prevent diabetes by getting people to be more physically active, make wiser food and portion choices, and seek preventive care from their doctors;
2.motivate people with diabetes and their health care providers to improve blood glucose and blood pressure control through education, regular follow-up, and economic incentives;
3.make sure every person with diabetes gets a dilated eye exam every year by an eye doctor knowledgeable about and experienced with diabetes.

We all know that our health care system needs major improvement, especially as we spend more per capita on health care than any nation, yet we have outcomes (disease, disability, and death) that rank below those of other industrialized nations. A major part of this problem is a focus on disease management rather than prevention. It is far more costly and increases human suffering to have a health care system that primarily treats chronic diseases and their complications, rather than one that puts a premium on maintaining health and optimally managing chronic conditions like diabetes to prevent and minimize complications. I came across a column by a diabetes educator recently that read: diabetes doesn't cause complications – poorly controlled diabetes causes complications! To put a finer point on this argument, I would add that a health care system that doesn't use every available tool to stem the diabetes epidemic in the first place and then, on top of that, doesn't fully engage both patients and doctors to effectively control diabetes is what really causes the complications of diabetes.

Cost-effective Measures
I am hopeful that President Obama's administration will affect some major health care reforms, particularly when it comes to both improving access and putting an emphasis on disease prevention. I think the President has made his position clear (though he needs vocal support and, yes, informed action from the American people) and I think that we in the diabetes community, both patients and providers, should heed his call. One way to do this is to educate ourselves about good diabetes management. Another is to ‘pay it forward' by helping to educate and persuade others affected by diabetes, whether they be family members, friends, colleagues, or fellow travelers who have diabetes or who are at-risk for developing diabetes. By extending this commitment to education and persuasion, perhaps we can influence policy makers at every level of government to adopt policies and create programs that best meet the needs of the diabetes community and our country.

To give one small example, I have sent emails and letters to my State and Federal legislators asking them to consider using tax policy to encourage the production and consumption of fruits and vegetables and discourage the production and consumption of highly processed foods containing hydrogenated oils, as research clearly shows the former promotes health (including eye health) whereas the latter increases the risk of obesity, diabetes, and cardiovascular disease (as well as eye disease). Undoubtedly, there are many complexities – political, financial, and social – which I have not fully appreciated in making this modest proposal. Nonetheless, I am convinced after reading thousands of scientific papers and examining the eyes of patients for more than 20 years that getting Americans to eat more fruits and vegetables and less processed, high-calorie, nutrient-deficient foods will result in less obesity, less diabetes, less cardiovascular disease, less serious eye disease (including diabetic retinopathy and age-related macular degeneration, two leading causes of severe vision loss), lower health care costs, and vastly improved public health.

Decreasing the Diabetes Cost
Diabetes care alone accounts for one of every six health care dollars spent in the US. We tax alcoholic beverages and tobacco products because we know they are detrimental to human health and because the purely economic interests of these industries were trumped by sound public health policy. That's been a no-brainer for some time. So, too, is this modest proposal. Imagine if a family could buy quality produce at a fraction of the cost of saturated-fat laden, high sugar, and high-sodium packaged foods, especially if the economic incentive is coupled with strong and consistent public education. Imagine if a Twinkie cost $5 while an apple cost 10 cents. Undoubtedly, some people would be unhappy for a while, but what about in the long run? It would save us all a lot money. It would save eyesight. It would save lives. It might just save the US healthcare system. I'd really like to know what readers of dLife think about this idea. Dear Mr. President – what do you think?


For more information on diabetic eye disease, consult Dr. Chous' book Diabetic Eye Disease: Lessons From a Diabetic Eye Doctor, Fairwood Press, Seattle, 2003.

Read more about Dr. Chous here.

Visit Dr. Chous' website here.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

Last Modified Date: June 28, 2013

All content on is created and reviewed in compliance with our editorial policy.

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