SA JOURNAL OF DIABETES & VASCULAR DISEASE
EDITORIAL
VOLUME 10 NUMBER 1 • MARCH 2013
3
Correspondence to: Dr Landi Lombard
Netcare Kuils River Hospital, Cape Town
Tel: +27 0(21) 900-6350
e-mail:
S Afr J Diabetes Vasc Dis
2013;
10
: 3
The pendulum is swinging
LANDI LOMBARD
M
y endocrinology trainingat the EndocrineUnit of Tygerberg
Hospital was under the supervision and watchful eye of
Prof Stephen Hough. He deserves credit for having built
up this unit, mostly on his own, over many years. He used to love
talking about how the pendulum swings in medicine, often from
one extreme to the other.
I think it is swinging again. In the past decades, the pendulum
swung towards private medicine and most doctors and specialists
left the public sector for the private sector or life abroad. The most
obvious reason was the poor salaries paid by the public sector, as
well as poor working conditions and the unavailability of medicine
and modern equipment.
In recent years however, public health has immensely improved
remuneration packages for doctors and nurses. Working conditions
have been upgraded and much money has been invested in
improving equipment. On the other hand, private-sector earnings
have not seen an inflation-related increase for a decade and
consulting specialties struggle to match the current salaries of
the public-sector health professionals. The risks they take and the
huge increase in funders’ administrative burdens have escalated to
unbearable levels.
Nursing care packages in the public sector have surpassed the
salaries of private-care nurses and we are losing nurses from private
hospitals. I expect many doctors to follow. The pendulum is surely
swinging again, this time in favour of public health.
Healthcare funders have become the monster that is slowly
devouring the noble profession of medicine. This frustration is
voiced in my article on diabetes treatment in South Africa. An
overview is given of the drugs available for diabetes care, compared
to the USA, and how funders are limiting the funding of various
options. I suggest a guideline for use in practice, based on the
current SEMDSA guidelines (see page 7). The
S Afr J Diabetes Vasc
Dis
asked Discovery Healthcare to state their perspective on how
diabetes influences their business, how many diabetic people they
look after, and the financial costs involved (see page 4).
Dr Webb and co-workers give case reports and advice in those
patients with type 2 diabetes and insulin-induced weight gain,
indeed a common phenomenon. They echo the view in my article,
which suggests we should use more GLP-1 analogues and DPP-4
inhibitors (see page 12).
I’m often quizzed by colleagues on when to treat and which
drugs to use. Prof Sinclair gives clear answers to these common
questions in a good overview of hypertriglyceridaemia in type 2
diabetes. He gives practical advice on the management of this
sometimes challenging problem, as well as discussing the NICE
guidelines (see page 18).
A practical guide gives sound advice on travelling as a person
with diabetes. It could be used as a hand-out or guide for diabetic
patients travelling overseas (page 32).
There has been much controversy recently regarding diets for
people with diabetes, especially after Prof Tim Noakes’ statements
on diet in diabetes. Dr May gives an overview and published data to
provide perspective on this difficult topic (see page 9).
I feel that private healthcare should reinvent itself by having
meetings between private hospital groups, healthcare funders
and private doctors (if possible) to discuss the future of private
healthcare. The lack of positive communication between these large
role players seriously hampers the potential of private healthcare.
