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Why I distrust the motives of those who want us to screen for pre-diabetes

It is with despair that I read about the plans for screening for pre-diabetes.

So is it going to be £332m each year to prove what we already know and to give advice that we should already be giving?

It was this impending emperor's new clothes scenario that was one of the reasons I finally left the pleasantly lucrative and intellectually satisfying sub-speciality of primary care diabetes.

Until a year or so ago, I used to travel to all areas of the country with a great team, teaching other GPs and practice nurses about diabetes. I watched myself gesticulating excitedly, getting enthused and trying to enthuse others about the potential the field afforded.

It was fun, I learned loads - but what was this niggle that I began to feel? Was I being hypocritical, teaching about drugs and advances that had so little relevance to the patients I saw in real general practice?

Why do the same names, the 'opinion leaders' come up in the literature all the time? Surely this was nothing to do with the vast amounts of money and opportunities for career advancement floating around?

I think I now know what I feel. Our approach to the increase in diabetes is intellectually dishonest because it is irrelevant to the wider world of gross inequity. Diabetes is purely a lifestyle issue, and a policy of pouring drugs into our patients stems from a motivation that is basically obscene.

I am tired of the defeatism and the collusion we show in assuming our patients are unable to change their lifestyles - they are. I now work in another very rewarding field, substance misuse, where I see clients every day who do just that.

The fact the remorseless tide of obesity continues is not a medical issue. It is a result of social policy. This is recognised by all, but we are still told that screening is part of the solution. I think I know who the real winners are here and it is not the ordinary taxpayer.

Dr Jim Newmark, Bradford, West Yorkshire

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