A Tale of Two Books

In my spare time this week I read a couple of books. Both books are about diabetes. Both are new and both are very well written. But that is where the similarities end.

The first of these books left me feeling that having diabetes was hopeless. So hopeless, in fact, that I despaired that my articles could make a difference in the lives of any but the most motivated readers. And perhaps not even for them.

It is unheard of to review a book and not even mention its title. But I won’t oblige. Any publicity is good publicity, and I wouldn’t be doing anyone a favor by leading them to the first book.

The second book could not have been a better antidote to the depression that the first book caused. This book does start out by describing how this society’s environment and the ensuing stress leads many of us into diabetes.

It notes the conventional wisdom that our genes or our bad behavior or a combination of the two causes our type 2 diabetes. Either we are doing something wrong or there’s something wrong with us. It’s blame-the-victim time.

But this book shows how type 2 diabetes is much more of a social disease than a medical one. The truth is that the disease is inherent in the society that surrounds us.

“The environment is set up to make people sick,” the book says. “It’s toxically high in sugar and stress and low in social support, opportunities to exercise, or to feel good about ourselves.”

If it stopped there, this book might be almost as pessimistic as the first. But after brilliantly setting out the problem, the bulk of the book in fact deals with the solution.

Since diabetes is a social disease, the solution must be a social one. Not a medical solution, since medicine itself in embedded in the society.

We can get healthier by joining forces to change our environment. We start by building our personal power – increasing our self-confidence and our self-esteem, setting positive goals, and giving ourselves reasons to live.

Then we build social power. We do this by working together. Only then can we change our environment.

This second book brought to my attention one of the most remarkable scientific studies of diabetes empowerment. The study is set among the Pima Indians of Arizona, who have perhaps the highest rate of diabetes of any group in the world and certainly have the highest rate of diabetes in America.

The scientists set out to compare a structured program of exercise and nutrition interventions – which they labeled Pima Action – with unstructured activities emphasizing Pima history and culture – Pima Pride. Those in the Pima Pride group got a more positive sense of themselves.

The scientists planned Pima Pride as a sort of control group. Fortunately, they had a real control group in those who declined to join either Pima Action or Pima Pride.

It was fortunate that they had this third non-participatory group as a control because the results shocked the scientists. After 18 months, the Pima Pride group had better results than the Pima Action group in everything they measured – weight, blood glucose control, waist size. But those who didn’t participate were worse off than either group. This showed that exercise and nutrition does help, but self-confidence and self-esteem helps even more.

There aren’t many studies as good as this Pima one. But there are many heros working to empower small groups of us all around the country.

The author of this book, David Spero, has met with these groups and their leaders, including America Bracho, an M.D. from Venezuela at Latino Health Access in Santa Ana, California, and Kate Lorig, a researcher and health educator at Stanford University, who started the Arthritis Self-Management Program.

The arthritis program started a revolution by using lay leaders instead of health professionals to deal with chronic illness. Those who participated in this program exercised more, felt better, and were hospitalized less than the control group.

Arthritis, like diabetes, is a chronic condition. The author of the second book that I read this week, David Spero, doesn’t have either illness. But for the past 25 years he has lived with an even more devastating chronic illness – multiple sclerosis. He has been a nurse for 32 years.

Since writing his first book, The Art of Getting Well: Maximizing Health When You Have a Chronic Illness (Hulter House, 2002), David Spero has led self-management and wellness groups for patients and has trained health care providers in the U.S. and Europe.

I’m still not going to tell you the name of the depressing book that I read first this week. Just as we are all better off by staying away from negative people as much as our work allows, we need to avoid negative books as much as possible.

But I have waited until now to tell you the title of David Spero’s new book. I wanted to tell you what it was about before I told you what it’s called, because I think that its name is misleading, with an emphasis that doesn’t reflect its contents.

Its title is Diabetes: Sugar-Coated Crisis: Who Gets It, Who Profits and How to Stop It. New Society published this 222-page paperback for $16.95 this month. The ISBN 13 is 978-0-86571-567-7; the ISBN 10 is 0-86571-567-X. In spite of the title, this is a great book.

This article is based on an earlier version of my article published by HealthCentral.