World leader

The CDC estimates that 8.3% of the U.S. population (all ages) have diabetes.

Surprisingly to me, the diabetes rate in the U.S. is far from the worst in the world. In fact, the International Diabetes Foundation puts the U.S. at 73rd in the world in terms of our diabetes rate.

The worst-off countries are in Oceania. The Marshall Islands, Nauru, and Polynesia are the hardest-hit. The International Diabetes Foundation estimates their diabetes rates among adults as 27.1%, 30.1%, and 37.3%, respectively. These countries' diabetes rates are nightmarish. Their obesity rates are nightmarish too: 71.1% in Nauru, compared to 35.7% in the U.S.

The reasons for this discrepancy are manifold, but a key player is the adoption of a Western diet. Whatever the cause, it's alarming that there is such a health burden around the world of diabetes. Diabetes is a huge health problem here in the U.S., where diabetic patients tend to have access to good treatments and medical care. I can't imagine what it is like for a country to have treble or quadruple our diabetes rate.

Picky canines

The patient needed a refill on his narcotics--in fact, several months' worth, because he was leaving in a few days for a long trip. I pointed out that, per our records, his last prescription had been filled recently. The patient's adult son, who cohabitates with his father, chimed in. "The pills get mailed to us," he said, "and they keep getting stolen right out of our mailbox. Big problem in our neighborhood. I have to take Norco for my elbow, and the damn thieves take my pain pills, too."

I relayed the story to the doctor, pointing out that it contained numerous red flags. The doctor mused that his patients use the same excuses to explain they need an early refill on their narcotics. Stolen from the mailbox is a favorite. Another classic is that the dog ate the bottle.

"Tell me, [Reflex Hammer]," he said, "how many times has a patient told you that they need a refill on their blood pressure medication, because the dog ate it?" He paused. "It's remarkable how dogs have such discriminating taste in pills."

Health stat of the day

According to the latest American Cancer Society estimates, lung cancer kills more Americans each year than breast cancer, prostate cancer, colon cancer, rectal cancer, and pancreatic cancer combined.

Cigarette smoking causes 90% of lung cancers. Is it trite to reiterate that smoking kills?

Unplanned and unwanted

A patient who is younger than me agrees to take a pregnancy test. It is positive. She sobs.

"Until now, I've always been fiercely anti-abortion," she says. "But, there's no way I'm going to keep this baby..."

Hoarders

"When you go to the bathroom and use some toilet paper, do you dispose of it?"

The patient hesitated. "That's a good question," she said. More seconds ticked by, still with no answer to my query.

The patient was a compulsive hoarder. By her admission, her house had become virtually unlivable. She couldn't even find her medications or her telephone, because they were completely buried in an ever-accumulating pile of junk. She came to our clinic desperate for help. She couldn't bring herself to throw anything away. She had spent what little money she had on hiring a professional crew, but when they arrived she refused to let them throw away any of her belongings. She was stuck. Repeated fines from the city for keeping her yard in disarray were adding up.

We did what we could: we gave her encouragement, we crafted strategies of how she could begin to tackle the problem, and we referred her to a psychiatrist (she had already been referred multiple times in the past). We even talked about different TV shows about hoarding and tried motivating her to watch an episode. We probably accomplished nothing. She might not even schedule her appointment with the psychiatrist, because she can't locate her telephone.

Some patients' problems are way beyond our powers. Practicing medicine is sometimes an exercise in helplessness.