Dialogue: Prevention best cure for diseases from bad diet

By BRIAN RUDMAN

Can anything be crazier than the convoluted debate going on about the ins and outs of testing an experimental diabetes cure in the Cook Islands? Here we have a group of people eating themselves into early graves on grossly fatty meat off-cuts from New Zealand. Then along comes a medical white knight from Auckland offering a possible cure for one of the resultant consequences of the pigging-out.

His solution? To implant yet more animal bits into already diseased and overweight bodies in the hope that the foreign bit will do what its clogged human counterpart no longer can.

Why, you might well ask, don't they just stop eating the disease-inducing mutton flaps and go catch some nice healthy fish instead? That way, the Type 2 diabetes epidemic exploding throughout the Pacific would die down and no one would have to put themselves - and others - at risk of catching exotic, as yet unknown, pig diseases.

Equally topsy-turvy is the debate around the epidemic of tooth decay in our children and the long delays in their getting care.

So bad is the problem, particularly in rural New Zealand, that hundreds of kids are on long waiting lists for specialist dental treatment. Somehow it's the Government - and the dental professionals - who are getting it in the neck for not providing enough treatment, instead of the parents who have fed their children the tooth-decaying foods in the first place.

It was good to see a visiting dental teacher, Professor Paul Belvedere of Minnesota, ramming this public health message home in a letter to the editor a couple of days back.

Commenting on a Herald report on the agonising wait for treatment for some children, the professor wrote: "The report said that a Northland child not yet 3 years old had 32 cavities in only 22 teeth. This is criminal, but the parent or caregiver is responsible, not the dental profession."

He argued that instead of bashing the dentists, policymakers should focus on an education programme teaching "that dental caries are absolutely preventable".

His point is worth emphasising. In both epidemics it is as if individuals - or, in the case of the kids, their parents - have abdicated responsibility for keeping themselves or their kids healthy. Then when the inevitable happens, we, the people, are supposed to rush to the rescue.

As one of the lucky generation whose health care and education were almost fully funded by the beneficent welfare state, I've still got a soft spot for the idea of nanny state. But as I recall, the implied contract between citizen and the state over health went a bit further than just nanny giving out support.

We were expected to do our bit as well. With the free school milk went lessons in healthy eating. We were even given lessons in growing healthy vegetables.

For the girls it went further. They were taught basic cooking and household hygiene as well. On trips to the dental clinic we were taught about Bertie Germ and the awful things he would do if we didn't brush regularly and eat the right sort of food.

This message of personal responsibility that was gently indoctrinated into my generation seems to have got lost somehow - in the debates over diabetes and dental decay anyway.

Of course the kid with 32 cavities deserves urgent treatment. But just as important is teaching the parents that sweetened tea and sugary soft drinks are to blame.

And that they could be setting up the child for serious illnesses, such as diabetes and heart disease.

As Dr Bob McKegg, a dental expert and past president of the Public Health Association, said at the launch of Well Child Week last year, "the only excuse for tooth decay in children is parental ignorance - and that's a bad excuse".

It's the same with Type 2 diabetes, the sort that afflicts about 90 per cent of New Zealand's 115,000 diabetics and most of the Pacific Island sufferers.

The Cook Islands MP representing New Zealand-based Cook Islanders is Dr Joe Williams. He is the person who encouraged Dr Bob Elliott to trial his pig implant therapy in the Cooks.

Dr Williams has a Mt Wellington practice and estimates 20 per cent of the Cook Islanders over the age of 50 who visit his clinic suffer from diabetes. Presumably they all eat too much of the wrong sort of food.

And the victims are getting younger by the month. Diabetes expert Dr Robyn Toomath says that increasingly obese teenagers are being diagnosed with what used to be called adult-onset diabetes. She heads a group in Wellington called Fight the Obesity Epidemic and wants a tax on fatty foods and a ban on the sale of soft-drinks and junk foods in schools.

While I don't see the fat tax as a starter, at least Dr Toomath is approaching the epidemic at the right end - trying to stop it at its source.

Prevention, after all, is easy in the case of most diabetes and dental disease.

As for the other end, that's a different story.

nzherald.co.nz/health