The Grumpy Doc – Grumpy opinions about everything.

Waiting For The Reichstag Fire

On February 16, 2025

On the evening of February 27th, 1933 the German Reichstag burst into flames. This attack on the German national parliament building was viewed by many as an attack on Germany itself.

A Dutchman named Marinus van der Lubbe was found and arrested at the scene almost immediately after the fire erupted. The Nazis quickly claimed that the fire was part of a broader communist uprising and used this claim to push for emergency powers.

Van der Lubbe confessed to setting the fire alone, but the Nazi Party quickly claimed that it was part of a widespread communist conspiracy. Many people believe that the Nazis may have set the fire themselves and used it as a pretext to declare emergency rule.

Adolf Hitler persuaded German President Paul von Hindenburg to issue the “Decree for the Protection of the People and the State” which suspended civil liberties, including freedom of speech, press and assembly. It allowed for the arrest and detention of political opponents without due process. Thousands of communists and socialists were arrested.

Within a month new elections were held. While the Nazis did not win an outright majority, they used the fire to create fear that led to passage of the “Enabling Act” on March 23, 1933. The act gave Hitler dictatorial powers, effectively ending democracy in Germany.

The Reichstag Fire was a crucial point in world history. Whether it was a Nazi engineered false flag operation or the act of a alone arsonist, it provided Hitler with the excuse he needed to dismantle democracy and establish a totalitarian dictatorship. This is a chilling example of how fear and propaganda can be weaponized to erase freedom; a lesson that remains relevant today.

Telehealth: Revolutionizing Healthcare

By John Turley

On February 12, 2025

In Medicine

Or Is It Simply a Band-Aid?

When I first started hearing about telemedicine in the 1990s, I was dubious at best. How can I treat a patient I can’t examine? Too many things ran through my mind. I couldn’t listen to their heart, I couldn’t listen to them breathe, I couldn’t even look in their throat or their ears. What if I needed an EKG? How could I check their blood pressure? I was worried that telemedicine might be “second rate medicine”.

I was worried about misdiagnosis and overprescribing antibiotics. If you couldn’t actually examine a patient, you might decide to play it safe and prescribe an antibiotic whether it was really needed or not. It might result in people being sent to the emergency room who might have been treated as an outpatient if you could have examined them in person.

As I looked into it, I discovered that the idea of telemedicine was not really new. As early as 1879, the British Medical Journal The Lancet discussed the possibility of using the telephone, then a revolutionary new technology, to reduce unnecessary doctors’ visits. It took the advent of the computer age and audio-video technology to make telemedicine a real possibility. But even then, I was still skeptical. I preferred to see my patients in person and did not get involved in telemedicine until the great societal upheaval of COVID.

I happened to retire from the emergency department three months before COVID hit. I was still doing primary care two days a week for an employee’s clinic. Like everyone else, we were shut down.

Reluctantly, we decided the only way to provide a service to our patients was to start using telehealth. Of course, we had none of the audio-video equipment we needed so we initially did it by telephone. That just confirmed most of my worries about providing poor care. We soon acquired the audio-video capabilities which gave us a little more insight into the patients we were dealing with. Over the next few months, I learned who was and was not a good candidate for telemedicine and how I could best care for patients that I could not physically examine. I’m going to share with you some of the things that I’ve learned over the past four years. Thankfully telehealth is now an exception rather than the rule as it was early in COVID. But it’s here to stay and we need to learn how to make it work.

Advantages of Telehealth

Convenience and Accessibility: Telehealth’s most immediate and tangible benefit is convenience. With the simple click of a button, patients can consult a physician from the comfort of their home. This is particularly helpful for those living in rural areas or those who are physically unable to travel to a clinic or hospital. According to a study by the American Medical Association, telehealth has increased access to care for patients who otherwise might not be able to receive it, whether due to geographical limitations, lack of transportation, or mobility issues.

For working professionals or parents who find it difficult to carve out time for in-person visits, telehealth allows consultations to occur from anywhere, drastically reducing travel time and missed work or family obligations. Patients also benefit from shorter wait times, as virtual queues tend to move more quickly than physical ones.

Cost Efficiency: Telehealth services can be more cost-effective for both patients and healthcare providers. For patients, the expenses associated with travel, parking, and time away from work are minimized. Healthcare providers, particularly in large hospital networks, can allocate resources more efficiently by integrating telemedicine into their workflow. Many telehealth services also offer more affordable consultation fees compared to in-office visits. A report from the National Bureau of Economic Research found that telemedicine visits are often less expensive for both insurers and healthcare systems.

Continuity of Care: Telehealth allows for more frequent follow-ups, which is critical for managing chronic diseases such as diabetes, hypertension, and asthma. Instead of requiring patients to come to the clinic for every minor adjustment or medication change, telehealth allows for regular check-ins from home. This facilitates better long-term disease management and patient compliance. It can also enable quick intervention in cases where a patient’s symptoms escalate, potentially reducing the likelihood of emergency room visits.

Disadvantages of Telehealth

Limited Physical Examination: The inability to perform a comprehensive physical examination is a significant limitation of telehealth. While many aspects of healthcare can be effectively managed through conversation, video, and shared data, some conditions require a hands-on exam. For example, a doctor might not be able to detect subtle signs of a skin condition, a heart murmur, or abdominal tenderness through a video screen. This limitation can hinder accurate diagnoses and delay proper treatment.

Privacy and Data Security: Healthcare data is among the most sensitive forms of personal information. The shift to telehealth introduces significant concerns about data security, especially given the increase in cyberattacks on healthcare systems. The Health Insurance Portability and Accountability Act (HIPAA) mandates strict guidelines for protecting patient privacy, but not all telehealth platforms may be fully compliant. In some cases, platforms may use third-party applications that could compromise patient information. The risk of hacking, data breaches, or improper data handling adds another layer of complexity to the telehealth debate.

Connectivity Issues: High-speed internet is a luxury that is still not available in many rural and underserved areas. Telehealth relies heavily on stable and fast internet connections to facilitate real-time communication between patient and provider. In regions where broadband access is limited, telehealth appointments can be riddled with delays, interruptions, or complete disconnections. This not only disrupts the flow of the consultation but can also compromise the quality of care provided.

Lack of Universal Standards: Unlike in-person healthcare, where the processes are well-established and regulated, telehealth practices can vary significantly between providers and systems. The lack of universal standards for telehealth can lead to inconsistencies in the quality of care. Some platforms might not integrate well with electronic health records (EHRs), making it difficult for physicians to access a complete patient history during the virtual consultation. Platforms may not function seamlessly across different devices (i.e., Android vs. iOS) or different browsers. Technical support may not always be readily available to address these issues, leading to delays in care or missed appointments.

Medical Problems Not Appropriate for Telehealth

While telehealth has proven to be effective for certain conditions, it is not a one-size-fits-all solution. There are specific medical problems that necessitate an in-person visit, where a physical examination and specialized equipment are crucial.

Acute Injuries and Trauma: Telehealth is not suitable for diagnosing or treating acute injuries such as fractures, deep cuts, burns, or other types of trauma. These conditions require immediate hands-on evaluation, imaging (e.g., X-rays or CT scans), and possibly surgical intervention. A telehealth consultation cannot provide the necessary tools to address these problems adequately, and any delays in care could worsen the patient’s condition.

Cardiovascular Emergencies: Conditions such as chest pain, heart attack symptoms, or strokes demand immediate in-person evaluation. The time-sensitive nature of these issues means that telehealth would not be appropriate for diagnosis or treatment. Patients experiencing these symptoms require rapid testing, monitoring, and possibly life-saving interventions that cannot be performed remotely.

Neurological Symptoms: Patients presenting with acute neurological symptoms such as sudden onset of weakness, slurred speech, confusion, or seizure activity require immediate in-person evaluation. These symptoms could indicate a stroke, transient ischemic attack (TIA), or another serious neurological condition that cannot be diagnosed or managed through a telehealth appointment.

Surgical Consultations: While telehealth can be a valuable tool for follow-up appointments post-surgery, the initial evaluation for surgical candidates should take place in person. Surgeons often rely on physical examinations and imaging results to determine whether surgery is necessary and to plan the procedure effectively.

Striking a Balance

Telehealth has transformed healthcare in a multitude of ways, providing unprecedented access to care for millions of patients. Its convenience, cost efficiency, and ability to promote continuity of care make it a powerful tool in the modern healthcare landscape. However, the limitations of telehealth, especially in cases requiring hands-on care or in emergencies, cannot be ignored. As healthcare systems continue to integrate telehealth into routine practice, it is essential to strike a balance between virtual and in-person care to ensure that all patients receive the level of medical attention they need. For now, I believe telehealth should be viewed as a complement to, rather than a replacement for, traditional healthcare.

Hijacked Healthcare- A System In Crisis

By John Turley

On February 8, 2025

In Commentary, Medicine, Politics

For more than 30 years I have watched our health care system become increasingly more politicized. As a physician I have become concerned with the direction it has recently taken.

Until the early 20th century healthcare was mostly private, and medical expenses were out of pocket. Early calls for national health insurance began with labor organizations and were quickly joined by progressive politicians. President Franklin Roosevelt wanted to include health insurance in the Social Security Act of 1935 but was unable to get it passed. President Harry Truman also proposed a National Health Insurance program in 1945, but it was denounced as socialized medicine. All these efforts were opposed by business interests, conservative politicians — particularly southern— and surprisingly, the American Medical Association.

Finally in the 1960s as part of his “Great Society” programs President Lyndon Johnson pushed for the passage of both Medicare and Medicaid. Rising costs of health care under President Richard Nixon led to the introduction of Health Maintenance Organizations (HMOs) as an attempt to encourage cost efficiency. President Ronald Reagan reduced federal health care spending and pushed for more privatization. In the 1990s President Bill Clinton attempted to introduce universal health coverage but it was met by fierce opposition from the insurance industry, business, and the Republican Party who labeled it as government “overreach”. Finally in 2010 President Obama’s Affordable Care Act (ACA) also called “Obamacare” became the most significant health care reform since Medicare and Medicaid. It also faced legal challenges and political resistance with the Republicans consistently attempting to repeal it. During his first term, President Donald Trump reduced ACA funding and repealed the individual mandate penalty that had required people who did not maintain health insurance to pay a fee. The elimination of the penalty weakened the law and reduced the number of people who sought coverage. We can expect further efforts to weaken the provisions of the ACA but given that it is well entrenched in the US healthcare system now is unlikely that it will be completely repealed.

While early health care programs faced significant controversy and strong debate, progress in providing expanded coverage and improved care was continuous. I’m concerned that we’re about to enter an era where many of our gains in public health are going to be reversed. The United States remains unique among wealthy nations as the only one without universal health care and I fear that we will begin to lose what gains we have made over the past several decades.

I’ve written previously about my concerns with vaccine resistance and the elimination of vaccination requirements for school children. I believe that this is an impending public health disaster and I’m afraid there are even greater disasters on the horizon.

Robert F. Kennedy Jr has been nominated by President Trump to be the secretary of Health and Human Services and by the time you read this he may well have been confirmed. During his confirmation hearings Kennedy has made a few positive statements. He’s expressed an intent to increase focus on chronic diseases such as diabetes and obesity. He has indicated support for rural hospitals. He would like to increase training for physicians in addiction care and increase access to treatment programs. He is also indicated plans to improve American diet by targeting ultra processed foods, contaminants in food, and placing restrictions on food additives. He also has proposed reforms to include stricter FDA oversight of the food supply.

However, there are several very troubling aspects to his nomination. He has a history as a vaccine denier although he is currently denying that denial. He said he is not anti vaccine but is pro safety. He has stated he will support polio and measles vaccines and that all his children have been vaccinated. (In 2020, while speaking on the podcast of his nonprofit organization Children’s Health Defense, Kennedy said that he would do anything, pay anything to be able to go back in time to avoid giving his children the vaccines that he gave them.) Given his history of anti vaccine statements and the fact that he profits from anti vaccine litigation it’s likely he will return to previous anti vaccine positions once confirmed.

He has proposed significant changes to both the CDC and the NIH including significant staff changes. He has proposed redirecting funding to preventative/alternative medicine.

Most troubling is his poor understanding of Medicare and Medicaid programs. During questioning he showed a lack of understanding of the funding sources and statutory requirements of the two programs.

The Centers for Disease Control (CDC) faces considerable threat. House Republicans have proposed a $1.8 billion cut (22%) to CDC’s budget. These budget cuts target programs that address opioid overdoses, firearm injuries and food safety monitoring. This budget conflicts with Kennedy’s statements about his priorities and it remains to be seen how this will be resolved. The Heritage Foundation’s Project 2025 has advocated splitting the CDC into two separate entities: one for data collection and another for limited public health guidance. The intent is to reduce its influence on social policies. The administration has already imposed communications restrictions, requiring that CDC announcements, social media posts and scientific reports undergo political review. There is currently a proposal to reduce the in-house reviews of medical research; there is even a proposal to “deputize the public” to challenge scientific findings used in regulations. This would leave medical research open to review by the least qualified. Unfortunately, he current nominee for CDC director, David Weldon, a physician and former republican congressman, has signaled his intent to narrow the agency’s scope and his support for administration policies.

Highly contentious issues such as gender affirming care and reproductive health have already been severely restricted. It is likely that these areas will come under continued attack by the current administration.

This administration also poses a threat to global health. By executive order the US was withdrawn from the World Health Organization. Additionally, the US Agency for International Development (USAID) has been significantly reduced with all major programs placed on hold. Not only does USAID support foreign aid programs, but it is also a major player in global health.

USAID sponsored programs identify and monitor disease outbreaks, provide treatment and preventive measures for local populations and provide global disease alerts that help protect United States citizens. We are already seeing the beginnings of a worldwide humanitarian healthcare emergency. Not only will this affect healthcare systems but eventually the economic systems in countries who have lost their access to modern medical assistance. We will lose the advanced notice about disease outbreak and spread. Without this remote surveillance, it is possible that we may be caught unaware by the next pandemic until it is ravaging our population.

This administration claims to support “the average American” yet it seems to be intent on destroying all our health.

The Wisdom of Dietrich Bonhoeffer

By John Turley

On January 31, 2025

In Commentary, History

Dietrich Bonhoeffer (1906–1945) was a German Lutheran pastor, theologian, and anti-Nazi dissident. Born in Poland into an intellectual family, he pursued theology at the University of Berlin, earning a doctorate at just 21. His early work emphasized the importance of the Church in standing against injustice, a principle that would shape his resistance to Adolf Hitler’s regime.

In the 1930s, Bonhoeffer became a leading voice in the Confessing Church, a movement opposing Nazi influence in German Protestantism. He condemned the regime’s treatment of Jews and rejected the idea of a church subservient to state ideology. After the Nazis banned him from teaching and speaking publicly, he joined the German resistance, working secretly with military officers plotting to overthrow Hitler.

Arrested in 1943 for his role in the conspiracy, Bonhoeffer was imprisoned for two years, during which he wrote some of his most profound theological works, including Letters and Papers from Prison. The quotes below are taken from this work.

On April 9, 1945, just weeks before Germany’s surrender, he was executed at Flossenbürg concentration camp. His legacy endures as a model of Christian resistance, moral courage, and faith in action.

Quotes from Letters and Papers from Prison

“The impression one gains is not so much that stupidity is a congenital defect, but that, under certain circumstances, people are made stupid or that they allow this to happen to them.”

“Having thus become a mindless tool, the stupid person will also be capable of any evil and at the same time incapable of seeing that it is evil. This is where the danger of diabolical misuse lurks, for it is this that can once and for all destroy human beings.”

“Stupidity is a more dangerous enemy of the good than malice. One may protest against evil; it can be exposed and, if need be, prevented by use of force. Against stupidity we are defenseless.”

“Neither protests nor the use of force accomplish anything here; reasons fall on deaf ears; facts that contradict one’s prejudgment simply need not be believed – in such moments the stupid person even becomes critical – and when facts are irrefutable they are just pushed aside as inconsequential, as incidental.”

“In all this the stupid person, in contrast to the malicious one, is utterly self satisfied and, being easily irritated, becomes dangerous by going on the attack.”

Who Will Tell Our Stories?

By John Turley

On January 25, 2025

In Commentary

The Decline of Community Newspapers

“Were it left to me to decide whether we should have a government without newspapers, or newspapers without a government, I should not hesitate a moment to prefer the latter.” Thomas Jefferson’s words resonate now more than ever in today’s media landscape, where local newspapers—the cornerstone of informed citizenship—are vanishing at an alarming rate. But it is more than just newspapers at risk—it is our very democracy.

Growing up in Charleston during the 1950s and 60s, I witnessed firsthand how integral newspapers were to community life. From delivering The Gazette as a boy to relying on its pages for news of local events and government, newspapers were our primary connection to the world around us.

There weren’t a lot of options for news then. There were no 24-hour news channels. National news on the three networks was about 30 minutes an evening and local news was about 15 minutes. By the late 1960s national news had increased to 60 minutes and most local news to about 30 minutes. Given the limitations of time on the local stations, most of the broadcast was taken up with weather, sports, and human-interest stories with little time left to expand on hard news stories.

We depended on our newspapers for news of our cities, counties, and states and the papers delivered the news we needed. Almost everyone subscribed to and read the local papers. They kept us informed about our local politicians and government and provided local insight on national events. They were also our source for information about births, deaths, marriages, high school graduations and everything we wanted to know about our community.

While newspapers were central in the mid-20th century, the proliferation of digital and broadcast media in the 21st century has transformed how we consume news. There are 24-hour news networks, but they often are a case of too much time and too little news. There are the social media—X (Twitter), Facebook, Tik Tok, Instagram, Truth Social and many other online entities that claim to provide news.

Even though local television news has expanded its format and increased coverage of local hard news, it remains heavily weighted toward sports, weather, and human interest. It is somewhat akin to reading the headline and the first paragraph in a newspaper story. It doesn’t provide in-depth coverage, but hopefully, it motivates people to find out more about events that concern them.

Still, it’s the local newspapers that provide detailed news about local and state events. Here in Charleston our newspapers were consolidated into a single daily paper several years ago. Despite reduced staffing and subscribership, they still make a valiant effort to cover our local news. Eric Eyre provided Pulitzer Prize winning coverage of the opioid epidemic. Currently Phil Kabler, though officially retired, continues to provide insight into the legislature and state government. Mike Tony, another reporter deeply involved in the community, provides coverage of West Virginia energy issues and the ongoing business foibles of our former governor and now senator. Mike recently informed us of an inappropriate—possibly illegal—grant made by the West Virginia Water Development Authority to a private Catholic College in Ohio. The college espouses multiple far right conservative political positions, although they claim this will not influence their project in West Virginia. Mike also pointed out the state statutory requirements for the grant were not met and that the governor’s office, as usual, had no comment. All this was done while West Virginia communities that have been without safe drinking water for months did not receive grants or any other assistance to improve their water systems.

Will TV news ever be able to provide the details about our community? The format of the newspaper allows for more detailed presentations and for a larger variety of stories. The reader can pick which stories to read, when to read them and how much of each to read. I don’t believe that broadcast news will ever fill the role of a free press. The broadcast is an ethereal thing. You hear it and it’s gone. It is always possible to record it and play it back, but most people don’t. Newspapers by their very nature encourage critical thinking. You can read it, think about it, and read it again. There are times when on my second or third reading of an editorial or a news article I’ve changed my opinion about either the subject or the writer. A news broadcast doesn’t lend itself to this type of reflection. When listening to broadcast news I often find my mind wandering as something that the broadcaster said sends me in a different direction.

I worry about the future of newspapers. According to a study by Northwestern University’s Medill School of Journalism, more than 360 newspapers have closed nationally since the beginning of the COVID pandemic. Since 2005 over 3300 newspapers have closed or consolidated—more than one third of the nation’s total. The U.S. has also lost about 43,000 newspaper journalists, representing nearly two-thirds of the total. It would be a tragedy to continue losing newspapers and journalists at this rate.

I beg everyone to please subscribe to your local newspapers. I generally prefer the hands-on, physical newspaper though I understand many people prefer the convenience of the digital version and I find myself moving in this direction. Whichever version you prefer, please subscribe. Don’t pretend that online sources, such as Facebook, X, and Instagram will provide you with local news rather than just gossip. Even the online news feeds from the dedicated news networks such as CNN or Fox provide little more than headlines. There’s little you can use to make an informed decision.

Without local news, we risk losing touch with how local and state governments affect our lives. Without this knowledge, we may be at risk of losing our freedom. Many countries that have succumbed to dictatorship have first lost their free press. One of the first acts of the would-be dictator is to attempt to silence the free press.

In my opinion, broadcast news is controlled by advertising dollars and viewer ratings affecting their coverage and orientation. News seems to be treated like any entertainment program with the output designed to attract an audience, not present facts. I recognize that this can be the case with newspapers as well, but it seems to me that it’s much easier to detect bias in the written word than in the spoken word. Too often we can get caught up in the emotions of the presenter or in the graphics that accompany the story.

With that in mind, I recommend that if you want unbiased journalism, please support your local newspapers before we lose them. Once they are gone, we will never get them back and we will all be much the poorer as a result.

I will leave you with a final quote.

A free press is the unsleeping guardian of every other right that free men prize; it is the most dangerous foe of tyranny. –Winston Churchill

Demystifying Diabetes

By John Turley

On January 21, 2025

In Medicine

Understanding the Types, Symptoms, and Management

Have you ever wondered why your family doc asks you to get a blood test when you make a routine office visit? Checking your A1c is one of the reasons why. At any age, but especially as you get older, you need to watch for symptoms of diabetes. Caring for ourselves and others in managing this disease is important. Something as simple as planning a dinner for family and friends may involve thinking about a person’s dietary restrictions, particularly if they have recently been diagnosed and are not yet comfortable with the diet. Even if you are not diabetic, please continue to read as I’ve included pertinent information about this disease to help you understands how it can affect your family and friends.

Diabetes is a group of chronic conditions affecting millions of people worldwide and not all cases of diabetes are the same. The two most common types, Type 1 and Type 2, involve elevated blood sugar levels but differ in their causes and management. At its simplest, Type 1 diabetics do not produce insulin and require supplementation. Type 2 diabetics produce insulin, but their bodies are resistant to its effects. According to the American Diabetes Association, as of 2021, approximately 11.6% of the U.S. population, or 38.4 million Americans had diabetes. Additionally, almost one-third of Americans have prediabetes. This includes both diagnosed and undiagnosed cases.

This guide will explain the key differences between the two types, highlight the role of the A1c test in diagnosis and care, and explore the consequences of poorly managed diabetes. Additionally, we will discuss a related condition, prediabetes, which serves as an early warning sign for Type 2 diabetes.

If you have been diagnosed with diabetes you probably are familiar with most of what is in this article. If you have not been diagnosed with diabetes you may find it interesting as it describes the diagnosis, management and genetic properties of diabetes. It also discusses how you can support family and friends who are living with the disease.

Type 1 vs. Type 2: What’s the Difference?

Historically, terms like “insulin-dependent” and “non-insulin-dependent” diabetes, as well as “juvenile” and “adult-onset” diabetes, were used to describe these conditions. Modern terminology now reflects their underlying causes as Type 1 and Type 2 diabetes.

Type 1 Diabetes

Type 1 diabetes is an autoimmune disorder in which the immune system attacks insulin-producing cells in the pancreas. Without insulin, glucose cannot enter cells for energy, leading to its buildup in the bloodstream. Symptoms such as excessive thirst, frequent urination, fatigue, and unintentional weight loss often appear suddenly, typically in childhood or early adulthood.

Type 1 diabetes has a strong genetic component, with heritability estimates ranging from 40% to 50%. Having a first-degree relative—parents and siblings—with Type 1 diabetes increases the risk, but the inheritance pattern is complex. Identical twins have a 40-50% concordance rate for Type 1 diabetes

Management requires:

Insulin Therapy: Administered through injections or an insulin pump.
Dietary Management: Balanced meals to regulate blood sugar levels.

Type 2 Diabetes

Type 2 diabetes is often associated with lifestyle factors, including obesity, poor diet, and inactivity, though genetics also play a significant role. In this condition, the body becomes resistant to insulin, and over time, the pancreas may fail to produce enough insulin. Symptoms develop more gradually and may include fatigue, increased thirst, and slow-healing wounds.

Type 2 diabetes has an even stronger genetic component than Type 1, with heritability estimates ranging from 20% to 80%. First-degree relatives of individuals with Type 2 diabetes are about 3 times more likely to develop the disease. The lifetime risk is 40% for individuals with one parent with Type 2 diabetes and 70% if both parents are affected. Identical twins have a higher concordance rate (about 70%) compared to fraternal twins (20-30%).

Management strategies include:

Lifestyle Modifications: Weight loss, improved diet, and regular exercise.
Medications: Oral and injectable medications are the usual management choice, though insulin may be needed in advanced stages.
Reversal Potential: Some individuals can manage or even reverse the condition through sustained lifestyle changes.

Prediabetes: An Early Warning Sign

Prediabetes—first recognized as a distinct medical condition in the late 1990s—occurs when blood sugar levels are higher than normal but not high enough to be classified as diabetes. It is a significant risk factor for developing Type 2 diabetes and associated complications like heart disease. Risk factors include:

Being overweight, especially with abdominal fat.
Physical inactivity.
Family history of Type 2 diabetes.
Age over 45.
Certain ethnic backgrounds (e.g., African American, Hispanic, Native American, or Asian American).
Coexisting conditions such as high blood pressure, high cholesterol, or polycystic ovary syndrome (PCOS).

Early intervention—including weight management, improved diet, and regular physical activity—can often prevent or delay progression to diabetes.

Diet management: Keystone to Lifestyle Modification.

Managing diabetes involves maintaining stable blood sugar levels, and diet plays a crucial role in achieving this. While no food is entirely off-limits, certain restrictions help control blood sugar and prevent complications.

Carbohydrates are the primary focus in a diabetic diet, as they directly impact blood sugar. Foods like white bread, sugary drinks, pastries, and processed snacks should be limited due to their high glycemic index, which causes rapid blood sugar spikes. Instead, opt for complex carbs such as whole grains, legumes, and vegetables, which release glucose slowly.

Sugary foods, including desserts, candies, and sweetened beverages, should also be restricted. These items can cause unpredictable blood sugar fluctuations. If indulging occasionally, pair them with a protein or healthy fat to moderate the impact.

Saturated and trans fats, commonly found in fried foods, processed snacks, and fatty cuts of meat, should be minimized. These fats increase the risk of heart disease, which is already higher in people with diabetes.

The Role of A1c in Diagnosis and Management

The hemoglobin A1c test provides a snapshot of average blood sugar levels over the past two to three months. It is a critical tool for diagnosing and managing diabetes.

Diagnosis

Normal: Below 5.7%.
Prediabetes: 5.7% to 6.4%.
Diabetes: 6.5% or higher on two separate tests.

Management

For most people with diabetes, the goal is to maintain an A1c level below 7%. Individual targets may vary based on age, health, and risk of hypoglycemia. Some studies have found that Type 2 diabetics can suffer adverse outcomes from consistently lowering the A1c below 5%. All management decisions should be made in consultation with your physician. Never start, stop or change dosage of diabetic medications on your own.

Key considerations include:

Type 1 Diabetes: Insulin adjustments based on daily glucose checks and A1c trends.
Type 2 Diabetes: A combination of lifestyle changes, oral or injectable medications, and insulin as needed.
Prediabetes: Lifestyle modifications to lower A1c and reduce the risk of diabetes.

Consequences of Poorly Managed Diabetes

Failing to manage diabetes can lead to severe complications affecting nearly every organ system:

Cardiovascular Disease: High blood sugar damages blood vessels, increasing the risk of heart attacks, strokes, hypertension and reduced circulation to the legs.
Neuropathy (Nerve Damage): Tingling, pain, or numbness, particularly in the legs and feet, can contribute to infections and amputations.
Kidney Disease (Nephropathy): Damaged kidney blood vessels can result in kidney failure, requiring dialysis or transplant.
Eye Damage (Retinopathy): Diabetes is a leading cause of blindness due to damage in the retina.
Increased Infections: Impaired circulation and healing make infections harder to treat.
Diabetic Ketoacidosis (DKA): A life-threatening condition in Type 1 diabetes caused by acid buildup due to fat metabolism.
Hyperosmolar Hyperglycemic State (HHS): Seen in Type 2 diabetes, this condition involves severe dehydration and confusion due to extremely high blood sugar levels.

What Can You Do to Help?

Supporting a loved one with diabetes requires understanding, encouragement, and teamwork. Family and friends can play a vital role in helping someone manage their condition effectively.

Educate yourself: Learn about diabetes, its challenges, and treatment options. Understanding the basics of blood sugar levels, medication, and dietary needs enables you to provide informed support.
Be supportive, not critical: Avoid judgmental comments about their food choices or habits. Instead, encourage them to make healthier decisions without pressure or guilt.
Create a supportive environment: Keep healthy food options available at home and participate in physical activities together, like walking or cycling. This fosters a shared commitment to well-being.
Offer emotional support: Diabetes management can be stressful. Be a good listener and offer reassurance during difficult times. Celebrate their successes, no matter how small.
Attend appointments or classes: If invited, accompany them to medical appointments or diabetes education classes. This shows you’re invested in their health journey.
Learn to respond to emergencies: Know the signs of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) and how to act. This preparedness can be life-saving.

By being empathetic and proactive, family and friends can help a loved one with diabetes feel empowered, cared for, and less isolated.

Conclusion

Type 1 and Type 2 diabetes, though different, are both serious conditions requiring proactive management. The A1c test plays a vital role in diagnosis and long-term care, offering insight into overall blood sugar control. Proper management, including lifestyle changes, medications, and regular monitoring, can prevent complications and significantly improve quality of life. Staying informed and working closely with healthcare providers are essential steps to living well with diabetes.

By taking action early and consistently, individuals can mitigate risks and lead healthier, more fulfilling lives.

A Thought for Inauguration Day

By John Turley

On January 19, 2025

In Commentary

A lie doesn’t become truth, wrong doesn’t become right, and evil doesn’t become good, just because it’s accepted by a majority.

–Booker T. Washington

Ignorance Redux

By John Turley

On January 16, 2025

In Commentary, Medicine, Politics

On his first day in office, the new far right governor of West Virginia issued an executive order allowing for extensive exemptions from the school vaccination mandate. When taken with the nomination of a virulent anti vaxxer for Secretary of Health and Human Services, I am concerned that we are in a rush to allow our children to die of easily preventable diseases. With this in mind, I’m reposting my article The Triumph of Ignorance from last April. At that time—as you will see in the first paragraph—I had some hope. Those hopes have since been dashed.

“There are two ways to be fooled. One is to believe what is not true; the other is to refuse to believe what is true.”– Søren Kierkegaard

Saturday morning, I was reading in the newspaper about the resurgence of measles in West Virginia. I find it appalling that this disease should be returning, given that we have safe and effective vaccinations. What is next, polio, smallpox, or even plague? It is only through the unexpected veto by our governor that the ill-advised bill passed by our legislature to make all vaccinations virtually optional did not become law.

Some people may wonder why vaccinations are important. There are two principal reasons to ensure that a large portion of the population is vaccinated against communicable diseases. The first is that it reduces the individual vulnerability to disease. The person who is vaccinated is protected. But there is also a second, sometimes not well-understood, reason. That is herd immunity.

Communicable diseases require a large susceptible population to spread. When a significant portion of the population has been vaccinated the disease does not have the core of potential victims to allow spreading. This means that the vaccinated are protecting the non-vaccinated. However, it does require a large portion of the population to be vaccinated. The idea is that herd immunity will protect those who are unable to be vaccinated either due to age, allergies, or other medical conditions that would prohibit vaccination. It is never going to protect a large proportion of the population who just choose not to be vaccinated. For example, about 90-95% of the population needs to be vaccinated against measles to provide herd immunity.

So why do people who otherwise can be vaccinated choose not to be?

There are, of course, those who have true religious objections to vaccination. There are others who object to vaccination on the basis of personal autonomy. They believe their right to refuse vaccination outweighs any consideration of the health concerns of the frail members of our community.

There are many who mistrust the medical system. There were some cases in the past where unethical studies were conducted on unsuspecting populations. Given the rigorous oversight of medical research now, this no longer happens. Information about research into vaccinations and their safety and efficacy can be found on websites for the Centers for Disease Control and Prevention and the World Health Organization among others. (Website references are provided at the end of this post.)

What concerns me most are those who refuse to believe reputable medical authorities, government agencies, and mainline news services. They prefer to get their information from anonymous websites or from conspiracy theory websites that still give credence to the now-discredited 1999 study linking the MMR vaccine to autism. They completely ignore the fact that 10 of the 11 reported co-authors disavowed any part in the conclusions of the study. They also ignore the fact that the principal author was found guilty of fraud for personal gain as he was employed by the manufacturer of rival drugs. They also ignore the fact that he lost his medical license over his falsifications in this study. Yet, he is still cited in anti-vaccine literature as an expert source.

Equally disturbing is the fact that vaccine resistance has become a part of political identification. Certain reactionary political groups have, for some unfathomable reason, decided that refusing vaccination is a badge of their political allegiance. They seem to care more about maintaining their political purity than they care about science, public health, or even the welfare of their family and friends. Politicizing public health is dangerous for all of us. I’m not sure how we overcome this. It is easy to find the truth and verify it through fact-based studies, yet people refuse to do it.

I encourage everyone to work hard to ensure that our political leaders do not remove vaccination mandates for school children. For those of us of my age, we already have immunity through vaccination or prior exposure to the disease. It is our grandchildren and their children and their children’s children who will suffer through the return of these deadly diseases.

SOURCES:

World Health Organization: https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1

CDC: https://www.cdc.gov/vaccines/index.html https://www.cdc.gov/vaccines/hcp/vis/index.html

WV DHHR: https://oeps.wv.gov/immunizations/Pages/default.aspx

Immunise.org: https://www.vaccineinformation.org/

What Would Jefferson Think About Inserting Religion Into Public Education?

By John Turley

On January 13, 2025

In Commentary, History

Jefferson on Religion

Thomas Jefferson had strong views on the separation of church and state, and based on his writings, it’s likely that he would have opposed any attempt to inject religion into public education. Jefferson’s views on religion were deeply influenced by Enlightenment principles, particularly the era’s emphasis on reason, skepticism of traditional authority, and commitment to individual liberty.

While Jefferson respected personal religious beliefs, he believed religion should remain a private matter, free from government influence. His 1786 Virginia Statute for Religious Freedom declared it immoral to compel anyone to support or participate in religious activities, emphasizing individual choice in matters of faith. This stance guided his actions, including the disestablishment of the Anglican Church as the official church of Virginia after the Revolution.

He famously wrote about the need for a “wall of separation between Church & State” in his 1802 letter to the Danbury Baptist Association. This idea became one of the foundational principles behind the First Amendment’s protection of religious liberty.

Although Jefferson was not opposed to religious belief, he supported individual freedom of conscience and he was adamant that religion should be a personal matter, not one enforced, promoted, or influenced by the government.

Religion in Education

When it came to education, Jefferson was passionate about public schooling and saw it as essential to maintaining a democratic society. He believed in the importance of a secular education system that promoted knowledge and reasoning. Jefferson envisioned public education as a way to cultivate informed citizens who could participate in self-governance.

Jefferson’s University of Virginia reflected these ideals, excluding religious instruction and ensuring a secular educational environment. He insisted that religion be studied alongside philosophy and ethics, rather than as a doctrinal subject.

If Jefferson were to assess attempts to inject religion into public education today, it’s reasonable to assume he would view such efforts as a violation of the principles of religious freedom he worked to establish. Jefferson would likely argue that public education, funded by taxpayer dollars and serving people of diverse religious backgrounds, should remain secular to respect the individual rights of all citizens. For him, blending government and religion risked infringing on personal freedoms and undermining the equality of all citizens under the law.

He would probably agree with later interpretations of the Constitution, such as Supreme Court rulings that have affirmed the separation of church and state in the context of public schools. These decisions typically uphold the principle that government institutions, including public schools, should not promote or endorse any particular religion.

Thomas Jefferson’s views on religious freedom, the separation of church and state, and public education suggest that he would strongly oppose any attempt to inject religion into public education. He believed that the role of public schools was to educate citizens in a way that fosters critical thinking, civic engagement, and respect for individual liberties, including the right to practice any religion or none at all. For Jefferson, keeping religion out of public institutions was essential to preserving a free and diverse society.

Jefferson’s unwavering commitment to individual liberty and reason over dogma continues to resonate, emphasizing the enduring value of secular education in fostering democratic principles.

A Thought for Today

By John Turley

On January 7, 2025

In Commentary

Today citizens get their news from a kaleidoscope of sources, some reliable many not—and we’re pretty sure it’s the other guy, not us, who is being taken in by partisan propaganda and fake news.

Madeleine Albright, Fascism: A Warning