Diabetes
Speakers: Dr. James Marks (click here for biography)
Soap Summit 4

Transcript of Proceedings
October 9, 1999

SONNY FOX: Dr. James Marks was the first member from the CDC family to work with us at our very first Soap Summit. We were all getting into this together and not quite knowing where it was going to go. Lucy Johnson will remember that they came into Loews Santa Monica Hotel with their arms just a little bit like this - wondering where the next blow was going to rain on them. Someone was going to tell them that they were worthless people, and that they were the reason that the social fabric of America was unraveling.

It was a getting-to-know-you session, and as a part of that Jim was an important factor in bringing you the message of how important you are and why he was there. Jim then was also a subsequent factor. I'm happy to welcome him back as the Director of the Center For Chronic Diseases. Which, as you all by now, have heard me say I'm sure, is the one of the worst titles I've ever heard for trying to get people interested in what you're doing.

Chronic is a bad word. And he has diabetes and cancer in his division. He's got heart disease. This guy's got the killer diseases. So I have re-christened it the Killer Disease Division.

What we've asked Dr. Marks to do today, is play a game with you. I have no idea what's he's prepared. I just give him the apples. He makes the pie. So without further ado, I present to you the Director of the Center for Killer Diseases from the CDC, Dr. James L. Marks

DR. JAMES MARKS: Sonny thought that it was a real stretch for me to not say those horrible things to people about what the soaps were. Coming from the government, we know what it's like to be told we're the source of all the problems in our society. And it hurts. So, never fear.

Frankly, this morning sounded to me like what I remember of freshman English. It was called Sex and Death. And what I have 20 minutes to talk to you about is all that's in between. And there's a lot.

I' m going to talk about some of the killer diseases. Sometimes they are not glamorous. They're rarely depicted in shows, certainly in shows that begin and end in a half hour. Yet they offer a lot of possibilities for development over time, and are so meaningful to such a large part of the American public, that Sonny and I thought it would be good to go over some of these with you.

Since you are from the television industry, I thought I'd start out by introducing some of these using a T.V. style format. Namely, that of the game show Jeopardy. I'll provide the answer. Maybe you can give me the question. If not, of course I'll give you that too.

First, under the category Times Ten and the answer is it kills ten times as many women each year as breast cancer.

AUDIENCE: Heart Disease.

DR. JAMES MARKS: Exactly right. Most American women think that breast cancer is the major threat to their health. They don't realize that about 45,000 women die each year of breast cancer, but over 500,000 die each year from cardiovascular disease, largely stroke and heart disease. That's even more than men that die of it. Do you know what is the leading cause of cancer deaths among women?

Lung cancer. Lung cancer kills 50 percent more women each year than die from breast cancer, which is the second leading cause in women. Again, nearly ten times as many women think that breast cancer is their leading cause of cancer death. In our new category, Viagra and other overnight success stories, the answer is that this disease is the leading cause of impotence in American men. Thus the reason for Viagra, prescriptions.

AUDIENCE: Diabetes?

DR. JAMES MARKS: What is diabetes, exactly right.

SONNY FOX: Doctors in the audience can't answer these questions.

DR. JAMES MARKS: Well, you're right, Sonny, most doctors can't answer these questions, so we're working on them. And if you didn't know, Viagra is a drug that sold the most prescriptions its first year of release than any other drug in history. I don't know much about the soap opera genre. I do know from what I hear from you, and what I know from my folks and relatives that do watch, is it's mostly about relationships and feelings. And in so many ways these chroaic illnesses are as well. These are killer illnesses. And I'm going talk to you about a couple of those concepts. But first I want to give you a little bit more background. Three out of four in this room will die of heart disease, cardiovascular disease or diabetes. If you're talking about anything else, you're operating at the margins of the killer conditions. Almost everyone knows someone in their family, with their relatives, their friends, who have one of those three conditions.

The rates really start to accelerate in the thirties, especially the late thirties. So that by 35 and above, those are the leading causes of death. People don't realize it starts that young. By the time they're over 65 one in six will have diabetes, diabetes alone. That is not including the numbers of those that will also have heart disease or cancer. And these numbers are rising rapidly. The aging of the U.S. population is, I'm sure, one you' re all having to grapple with. In fact the age group that you're not supposed to target is the one that's the fastest growing.

You're supposed to target 18 to 49 year olds. And it's those that are 50 and above, that's the fastest growing. It's the baby boomer age group that is going to bankrupt this society unless we can do something very different. This country spends 50 percent more than any other country in the world, per capita, on health care. We are the only one of the leading countries that does not provide health insurance for everyone.

By any measure we get poor value for our health care dollar. The number of people who are going to be in the oldest age groups is going to double in the next 20 years. I'm not someone who can write a script for the soaps, at least not a script that anyone would watch. But I do hope that I can give you some understanding about how these health issues, that so many American families face, might be able to be woven into some of your storylines.

I've told you the three diseases. I also want to mention there are three things that are the major causes of those of death. Tobacco, and I could say tobacco, tobacco, tobacco, 'cause it is that great. Tobacco will be the leading cause of death worldwide within 20 years. Tobacco causes one in six deaths in this country. Lack of physical activity is the other. Over-nutrition, meaning things like hypertension, elevated cholesterol, and things like those affects all of those three conditions, cancer, heart disease, and diabetes. I'm raising these with you because you heard the information from the survey. Your audiences get their health knowledge and act on what they see from your stories. You make the statistics that I gave you real. You put a face on them, faces that the audiences care about more so than any other part of television. That's a tremendous responsibility you have, and it's a tremendous gift.

I can't talk about everything or even a few things in any depth. I'm going to concentrate on two. I'm going to concentrate on cardiovascular disease, heart disease and stroke. And then I'm going to concentrate a little bit on diabetes.

Cardiovascular disease and stroke is the lead killer disease. That's not news to you here, but it is news to many. And it is news to many that it starts at such a young age

Overall, about 160,000 people in the U.S. between the ages of 35 and 64 die each year from these conditions. It is the one that people think about when they say if I'm going to go, I want to go quickly. I want to have a heart attack or a stroke and die right there. That's the image we have. We see resuscitations being attempted, and sometimes failing on TV. In fact for most people, that's not the way it happens. They have a heart attack or a stroke and become disabled. They live with the limitations in their lives. Even if they don't have those acute events, like elevated blood pressure, things like needing bypass surgery affect greatly how they think of themselves, how they work, in their families.

It starts out as angina, chest pain or exertion or when angry. If the person's fairly young, he or she might not take it seriously and think it's heartburn. If a woman, the doctor might dismiss it, because they don't think that women get it at younger ages. Doctors are much more likely to miss this in women, even though more women die of it than men. If a person does eventually get the right diagnosis, the individual may not want to tell partners, the boss or co-workers. They're worried about their job, their promotions. Good assignments are no longer being given to them but to younger co-workers. They're not comfortable with the vulnerability. They hide it, not wanting to worry their partner if they have been the one that's been in charge. If they're worried, or even a little depressed by it, they might get irritable, or even try to do more than they used to before. This can have a devastating effect on any relationship, aside from the impact of death. It's this side of the story that's not been portrayed.

There are many, many more millions who grapple with early signs and the life changes that they require. As you undoubtedly know, there can also be life affirming, positive changes in relationships that can occur with the struggling of an illness, or making the changes necessary to recover, or to avoid the limitations. With men with heart disease, interviews reveal that a primary fear among them is a fear of intimacy, more specifically sexual intercourse, because they literally feel it could kill them. Many will know someone who's having to deal with these issues now. It may be parents or spouse. Often it is not being discussed openly as communications remain superficial.

Much of what I said about heart disease and stroke can also be said about diabetes, though there are some differences. First a little more background there. The facts about diabetes leave no doubt about its seriousness. Many think of it as a touch of sugar, a little bit of diabetes, something they don't have to spend a lot of time or energy on. Currently there are estimated 10 million people in the U.S. have been diagnosed with it, a 600 percent increase since the 1950s. Another five and a half million people have it but don't know they have it. It's the leading cause of blindness among working age adults.

It's the leading cause of amputation in this country. It's the leading cause of kidney failure. There are two types. Type one usually gets its onset in childhood or as a young adult. Mary Tyler Moore has that, and has become an outspoken advocate for work to find the cure for that. The other is type two, much more common. 90 to 95 percent of candidates for diabetes are probably over 40, overweight, under-exercised. That's the person that is at risk. And that's the type of person who is increasing so rapidly in our society.

Diabetes is twice as common among people of Hispanic background and African-Americans. It's even more common among Native American populations. It's more common among women than among men. One of the most psychologically devastating impacts of diabetes is impotence, erectile dysfunction, as Bob Dole calls it. It occurs in about 30 percent of all men with diabetes and 60 percent of those over 60. That's about two to three times the rates in the population at large. Obviously this causes of a lot of distress and disappointment for patients and their partners, which only makes the problem of impotence worse.

One of the things that is especially difficult about diabetes is that initially the symptoms are very subtle. Loss of energy. Fatigue. So it often goes undiagnosed. And in fact in this country, on average, a person has it for seven to ten years before it is diagnosed. During that early time, they can experience some of the symptoms. Impotence is one of those. Before they know they have diabetes they're starting to have erectile dysfunction. Another symptom is wide fluctuations in the blood sugar so that it affects their personality. They become edgy, easy to anger, and forgetful. This creates problems professionally, with friends and family, but with no obvious source of why this is happening. And it's uncommon. Sometimes they may get diagnosed not because of those kinds of symptoms or others, but because they're actually having some other complications, affecting their vision, things like that.

With the diagnosis, psychological problems occur. Anxiety and depression commonly develop. The person with diabetes, as with most of the killer diseases, regardless of how good medical care, is the real manager of his or her condition. One has to take medication everyday, often several times a day.

Those with diabetes have to test their blood by pricking their finger several times a day. They can't have their lunch delayed a half an hour, or they start to have problems. They have to increase their physical activity, make sure they visit the doctor several times yearly. They should have their eyes checked annually for the beginning signs of the problems. Many of these developments affect life how the family operates and gets a long. It might lead to modifying the diet in the family, taking walks together, things like that. But some resist these changes. Some resent them. They don't like the food changes, the scheduling necessary. Beverly said this morning, in talking about the issues of trying to have a baby, that it's the little things in the relationships that actually gnaw on you in a way, and attack how people are getting along. It's not necessarily the condition itself. That's what happens in all of these.

You can see how difficult this can be. But often overlooked is the fact that also most of these problems can be solved or managed when the disease is brought under proper control. And this is another perspective we learned from people talking about it, from talking with their families and in focus groups.

Many think diabetes is just plain bad luck, nothing you can do about it. It's a difficult attitude to change. As with most of these conditions what people fear most is the sense of the loss of control over their lives. Diabetes can take away much more than health. It can take away your whole sense of who you are. Among people who learn how to control diabetes, to deal with their early signs of heart disease, some actually become grateful. It ends up that they take better care of themselves than they ever did before. They put things in perspective. A way to reach Americans, especially men, is to tell them that they need to take care of their diabetes or high blood pressure not necessarily for themselves but for their families. This was also important for women. This means that not only the people with diabetes can take back control of their lives that may have been lost to the disease, but also the people who love them can have a significant impact by making the issues of taking control a permanent part of their lives.

I'm gonna close here with a personal story. My grandfather died of a heart attack probably related to his poorly controlled diabetes at age 61. Neither of his brothers made it to age 65. My dad also developed diabetes at about the same age as my grandfather did in his mid-fifties. My dad retired at age 63, took up walking, lost 30 pounds, and eventually had to go to a diabetes specialist because he was having low blood sugar. He was doing so well he needed to have his medications cut way back.

A couple of years ago when I was talking to him on the phone he told me he had always set making it to age 65 as his goal. Anything past that was profit, given what had happened to his dad. He's 78. He still walks three miles a day, works part time, and does three or four consultancies a year for small businesses. About a year after I made that call he slipped on the ice during his walk and broke his shoulder blade. It was really painful, and it couldn't be put into a cast. If you have that happen, you know you can't dress yourself, you can't do your walking. I knew it bothered him but I didn't really know how much. This July I called him on his birthday. This is now 18 months after that happened. Talking about it, I asked how he was doing, he said he was feeling pretty good. And I said, you know, what do you mean? Normally he doesn't talk about that. He talks about what's going on. He said, well, he had resumed ordering his magazine subscriptions for two years rather than one. It turned out that he had been depressed about how his healing was going after the fall, and he had gone on to a one year schedule. Now feels better. I don't think he ever told my mother this. I know he hadn't told me or my brothers or sisters. Now he's older than most of your audience. But many will have relatives like this who are dealing with these kinds of issues.

I know that he will die eventually - probably from diabetes and its complications. But I also know that he has 15 to 20 more years, good years, than he would have had. For me, that's all that matters.

It really is about the feelings and relationships for all of these conditions that your stories are about, and that these conditions are about. Thank you.