The End of Diabetes Is within Reach
By Satesh Bidaisee
St George’s University
The Food and Drug Administration just approved what could be one of the biggest breakthroughs in the treatment of type 1 diabetes in decades.
Dubbed an "artificial pancreas," the MiniMed 670G is an implantable pump that senses blood glucose levels and delivers precise insulin doses to diabetic patients. Devices like these could make syringes for injecting insulin and manual blood monitors obsolete.
Unfortunately, victories like this in the battle against diabetes remain rare. Even though the condition is one of the top causes of death in the United States, research into it is grossly underfunded. Just as troubling, public awareness of how to prevent diabetes -- and how to manage it effectively -- remains inadequate.
The medical community has the power to stop the diabetes epidemic in its tracks -- but only if it makes diabetes research and education a bigger priority.
About one in 10 Americans currently suffers from diabetes. Worse, incidence of the disease has been rising for years. The number of cases in the United States shot up 44 percent between 2004 and 2014.
Diabetes takes a toll not just on the health of millions of Americans but on the economy, too. The disease costs Florida over $24 billion a year -- and the entire country about $250 billion annually. That's bigger than the yearly economic output of most states.
Compared to these staggering treatment costs, research funding for diabetes is a pittance.
Consider that the disease kills 28 times more Americans each year than HIV/AIDS. Yet the National Institutes of Health spend nearly three times as much annually on HIV/AIDS research as on diabetes research.
Given the enormous promise of today's diabetes research, this lack of funding is a missed opportunity.
Researchers at Harvard and MIT, for instance, are exploring a technique for making large numbers of insulin-creating cells that, once delivered to type 1 diabetes patients, could keep the disease at bay for years at a time. Johnson & Johnson, together with biotech firm Viacyte, is currently developing the first-ever stem-cell treatment for diabetes.
In short, we've never been closer to curing diabetes. But meeting that goal will take far longer if research funding remains as sparse as it is today.
Halting the epidemic will also require a more aggressive effort to prevent and diagnose the disease. More than one-third of American adults have pre-diabetes -- the kinds of elevated blood sugar levels that often lead to diabetes. Yet 90 percent of these individuals aren't aware of their condition.
This is where government agencies and academic institutions could have a significant impact.
The school I teach at, St. George's University in Grenada, has already taken up this cause. We're collaborating with Grenada's Ministry of Health on a school nutrition policy to advocate for healthy consumption habits. We've also worked with the ministry to launch programs that promote physical activity in schools and offer exercise classes to the community.
Ending the diabetes epidemic is within reach -- if we commit to funding the most promising medical research and effectively educating the public about the disease.
(Satesh Bidaisee is an Associate Professor of Public Health and Preventive Medicine and Assistant Dean for Graduate Studies at St. George’s University, Grenada)
H.R. McMaster: The Best Choice for National Security Advisor
By Dr Earl Tilford
President Donald Trump has selected the best possible person to serve as his national security advisor. Army Lieutenant General H.R. McMaster epitomizes the warrior-scholar in the tradition of Carl von Clausewitz.
The US Army was out of Vietnam for 11 years when, in 1984, McMaster took his oath as a second lieutenant at West Point. He was a cadet when Army Colonel Harry G. Summers, Jr., a Korean War and two-tour Vietnam War combat veteran, published “On Strategy: A Critical Analysis of the Vietnam War.” His controversial thesis was that the Army wasted time focusing on counter-insurgency—something he dubbed “lunging at the toreador’s cape” in a guerrilla war. This weakened the Army and strained American will so much that by the early 1970s, when the conventionally arrayed People’s Army of Vietnam assumed the major role in the war, broken American forces had mostly withdrawn. By 1974, a decade before McMaster, the Army entered recovery mode. Colonel Summer’s book legitimized criticism among military professionals of the Vietnam-era Army.
On the night and morning of February 27-28, 1991, Captain McMaster led Eagle Troop in the Battle of 73/74 Easting. His tank company—consisting of 120 troops manning nine M-1A1 Abrams tanks and a dozen M3 Bradley fighting vehicles—engaged and destroyed 28 Iraqi tanks, 16 armored personnel carriers, and 30 trucks in a half-hour. Shortly thereafter, his company encountered and destroyed another 20 Iraqi T-72 tanks.
Five years later, McMaster was completing his doctorate in history at the University of North Carolina under professor Richard H. Kohn. During the early 1980s, Dr Kohn had been the civilian chief of the Office of Air Force History, where US Air Force historians wrote a 14-volume official history of that service’s role in the Vietnam War. Kohn understood the service’s reluctance to critically examine a war that many of its top generals claimed to have “won” during the 11-day pounding of North Vietnam conducted largely by B-52s in December 1972. The Air Force had a much more difficult time accepting the Vietnam War as something other than an unbroken string of unmitigated air-power victories.
During the post-Cold War 1990s, the Army, having reorganized into the all-volunteer force and derived some honest lessons from Vietnam, looked to a future “digitized battlefield” where it would find, fix, and annihilate enemy forces. At Ft. Irwin, California, Major McMaster served as operations officer for the armored Opposition Force (OPFOR), a tank brigade structured and largely accoutered like foreign (primarily Russian) brigades, employing their tactics. McMaster, already a credentialed historian with his dissertation, “Dereliction of Duty: Lyndon Johnson, Robert McNamara, the Joint Chiefs of Staff and the Lies that Led to Vietnam,” published by Harper-Crown, was learning to think like the enemy.
In the 1990s, the Army War College and Army Training and Doctrine Command (TRADOC) devised the Army After Next (AAN) program to look 25 years into the future. Army Major General Robert Scales, Jr., a Duke University, PhD, controlled the project. Unfortunately, three events derailed the AAN:
The institutional US Army missed the Soviet Army grounded in its blitzkrieg doctrine, rich with tanks, artillery, and air-mobile divisions. The US Army’s Crusader mobile gun system, upgraded M1A2 Abrams tanks, and a proposed stealth “Comanche” helicopter, were projected for the Army to serve on the digitized battlefields when the Russian Bear revived by the 2015-2020 timeframe. Russia revived but the US Army got sidetracked.
Part of the sidetracking was opposition from the Army’s “Old Guard” to which General Scales belonged. Their tunnel vision focused on traditional army missions and branches of armor, infantry, artillery, aviation, engineers, etc. When futurists at the Army’s Strategic Studies Institute predicted a likely paradigm comprised of Islamic terrorists groups possibly armed with weapons of mass destruction, the traditionalists envisioned a rerun of counter-insurgency; special operations focused forces prompting neo-Vietnam nightmares.
September 11, 2001 ended the AAN. The all-volunteer Army, restructured to fight one war intensively for a short time—while revamped Reserve and National Guard components mobilized to “finish off” the enemy—found itself involved in Afghanistan and then in Iraq and mired in unconventional warfare. The Army, as McMaster testified, suffered. Another Vietnam-like quagmire seemed possible. He also headed the Army’s next future’s program.
The man and history converged. Knowing that history not only determines the eternal now but also provides the only substantial guide to the future, General McMaster has—and will continue—to embrace the strategic challenges facing the Army. As the president’s top advisor, McMaster’s challenges now operate on a global scale. He has the combat bona fides, the strategic intellectual acumen, and that essential attribute for leadership—personal integrity—to serve well the president and the nation. God’s speed, H.R.
(Dr Earl Tilford is a military historian and fellow for the Middle East & terrorism with The Center for Vision & Values at Grove City College)