Author: Robert Cucin MD JD MBA

The Public Speaks: Tackle the Type 2 Diabetes Problem Directly

Robert Cucin MD JD MBA bariatric surgery, Diabetes, metabolic syndrome, obesity , ,

AP (3/8/17) reports that fewer obese people are trying to loose weight than in prior years and researchers wonder if fat acceptance could be one of the reasons. Given enlarging meal portions, mainstream plus size models, re-scaling of clothing sizes, and popular overweight leads in sitcoms, the hypothesis seems not just tenable but proven.  The frequent inability of patients to keep weight off after losing it with diet and exercise, or sometimes even after bariatric surgery undoubtedly contributes to this shift.  It is not at all unlikely that the political correctness to avoid the subject of weight also prevents some of the peer pressure that might conceivably reinforce the dieter’s decision to pass up that extra French fry.

Some studies have implicated some infections that could be partially behind the obesity epidemic.  Researchers have found evidence to suggest  that infection with the common Adenovirus-36 leads the body to create more and fatter stem cells.    This observer concludes the AP report alone suggests that Obesity is at least socially contagious because the increased prevalence of Obesity has already spurred a change in social mores.

Obesity is not the morbidity itself though it does create a cardiovascular load, mechanical stress on the joints, and promote sleep apnea and gastric reflux.  There are some healthy obese patients, mostly younger patients who exercise regularly, who haven’t yet developed metabolic syndrome or who are genetically gifted not to do so.  The Public Enemy #1 is the Type II Diabetes associated with the metabolic syndrome which frequently complicates Obesity.  There are an estimated 29 million Type II Diabetics in the U.S.  Type II Diabetes is the leading cause of kidney failure needing dialysis, the most frequent indication for non-traumatic amputations, and a leading cause of blindness.

As it is the visceral or “belly fat” within the abdomen which secretes resistin, a cellular hormone which antagonizes the body’s own insulin to cause Type II Diabetes, reducing the size of that noxious cytokine factory which functions as a life-shortening gland with Endoscopic Visceral Lipectomy (EVL) is a direct approach to the problem.  Incidentally, the patient might cinch his or her belt a notch or two right off the operating table and is expected loose a great deal of body weight afterwards.  But the restoration of normal metabolism and amelioration of Type II Diabetes is the immediate goal of the procedure.  Though less attention by patients to their weight is not at all a pleasing finding for physicians, it does suggest the public has already recognized the need to retarget our emphasis!  EVL does so.

The Mesentery Gets Recognition

Robert Cucin MD JD MBA bariatric surgery, Diabetes, metabolic syndrome, obesity , ,

The mesentery, that humble peritoneal fold suspending the bowel and providing its blood supply, has finally been recognized as an organ.  Prof J Calvin Coffey and D Peter O’Leary , PhD in a recent article appearing in the Lancet    propose that the mesentery be recognized as an organ in its own right.   We applaud the elevation of the mesentery’s status to the 79th recognized organ in the body.  Recognizing the mesentery as an organ, is important as it allows us to study its effect on maintaining healthy or contributing to diseased states.

We have maintained that the noxious cellular hormones secreted by the mesenteric fat constitute a deadly cytokine factory responsible for Type II Diabetes (resistin), hypertension (angiotensinogen), autoimmune diseases and cancers, blood vessel inflammation (TNF, interleukin 6, PAL-1), and hunger (neuropeptide Y).  And mesenteric fat causes sleep apnea and gastric reflux simply as a result of its bulk.

For decades, surgeons have intervened to remove tumors of the mesentery or to untwist it in cases of volvulus to save compromised bowel.  However, Endcopic Visceral Lipectomy may well be the first intervention explicitly directed at the mesentery’s function as an organ to crease a diseased state, namely metabolic syndrome and Type II Diabetes.  Bravo.

 

 

MedTech Status Mundi

Robert Cucin MD JD MBA technology ,

Quantum theory holds that everything that can occur happens at the same time until observation fixes the outcome.  The observation is not only determined by the perspective of the observer but also by the precision of the observation.  Since each event subsequent to the first observation plus/minus its margin for error determines one or more subsequent events, we can envision a broadening cone of future events through time determined by that first observation.

It does seem rather hapless to make any prediction based upon the current state of uncertainty in these early days of the Trump presidency, the liberal revolt against it,  and Brexit’s uncertain effect upon the UK and the EU.  That said, let’s venture to do so with an admittedly large margin for error from the perspective of an American medical device company bringing a new product through the F.D.A. approval  process and into the domestic and ultimately the world market.

The pluses.  The hold on the medical device tax and President’s Trump stated intent to ease regulatory burdens and reduce corporate tax rates favors development and production.  We see the U.S. stock market is hitting  new highs in anticipation of these favorable changes with $2.9 Trillion USD added market capitalization.  Uncertainties regarding EU survival and stability and even the terrorist threat from open borders favors foreign investment in U.S. Companies as a safe harbor.  Companies with overseas funds may be able to repatriate overseas cash without onerous tax burdens to spur domestic production and hiring.  If jobs are created, the velocity of money will increase to allow an increased and ready market for the purchase of newly produced products.

The maybes and minuses.   First of course, is the general uncertainty which tends to have a dampening effect on investment.  Even if the lowering of the corporate tax rate is retroactive,  it will be a minimum of a year before it has enough effect on earnings to justify the current stock multiples and valuations.  It is predictable the stock market will have a substantial correction upon the news it has anticipated and priced in as the changes slowly filter down to corporate bottom lines.  The strength of the U.S. dollar and the possibility of  tariff wars may not bode as well for international sales.  Rising interest rates may also add to inventory costs.

So how do we assess this grab bag of uncertainties?  We guage the environment as more positive than negative for domestic sales, corporate profits, regulatory approval times, stock prices, and investment.  And after the anticipated intermediate market correction, we believe the investment environment should be substantially improved without  likelihood of any substantial downside for U.S. medical  device companies in 2017 and 2018.  Time will tell, but this seer is currently wearing rosy glasses.