<<Disclaimer:  Verify this information before applying it to your situation.>>

The March 27th issue of Business Week (that is just now reaching the
newstands) has an article on how the large HMOs are beginning to use
databases to manage the diseases that their members have.  For example,
Kaiser Permanente has combined all of the data on their 84,000 diabetics
and found that although diabetes is the leading cause of blindness,
15-20% of their diabetic patients aren't getting their eyes checked
routinely.  Meanwhile, standard office visits aren't doing enough for
diabetic patients battling complex problems such as obesity and stress,
which make the disease worse.  Kaiser plans more agressive eye-screening
programs and may set up patient support groups and more access to
specialist nurses.

As noted in the Sprue-nik Press there is little commerical interest in
CD.  There is no money to be made on something that can be controlled by
diet.  However, the HMOs *do* have an incentive to find undiagnosed
celiacs as the cost savings to them could be enormous!  It is up to us to
convince them to be more proactive in seeking out the condition.

Along that vein I present the following which is part of a Canadian
Celiac Association survey where 1294 questionaires (out of 1937 sent)
were returned (82% biopsy proven).  It lists various symptoms and
misdiagnoses for celiac disease.

(1) When asked how many doctors they had consulted about their problem,
25% of 960 biopsy-proven repondents said one doctor, 29% two doctors, 17%
three doctors, 12% four doctors, 6% five doctors, 6% six to 10 doctors,
and 3% more than 10 doctors.

(2) Duration of symptoms experienced by biopsy-proven respondents before
diagnosis of celiac disease:

                                             Range*             Respondent
                    Median   Mean     SD    Maximum   No. of    Pct. of
Symptom             (years) (years) (years) (years) Respondents 960 Total
-------             ------- ------- ------- ------- ----------- ----------
Diarrhea              1.9     6.6    11.7     75        774        80.6%
Abdominal pain        2.0     8.0    12.4     65        583        60.7
Gas or belching       2.5     8.4    13.0     74        629        65.5
Fatigue or lethagy    2.0     7.9    12.6     79        688        71.7
Bloating              2.0     7.9    12.4     79        770        80.2
Nausea or vomiting    1.0     5.8    10.9     65        334        34.8
Lack of appetite      1.0     6.2    12.7     70        330        34.4
Skin rash (DH)        4.0    10.3    13.0     57        155        16.1
Headache or migraine 10.0    13.9    13.9     62        204        21.3

* minimum range is one month for all symptoms

(3) Diagnoses of diseases made before celiac disease was diagnosed:

                              Respondents (%)
                       Biopsy Proven   Not Biopsy Proven
Diagnosis                 (N=686)           (N=145)
---------              -------------   -----------------
Anemia                      47%               30%
Stress                      45                39
Nervous condition           41                39
Irritable bowel             34                43
Stomach ulcer               23                14
Food allergy                19                32
Colitis                     13                23
Menstrual problems          13                17
Edema                        9                 8
Gallstones                   9                10
Diverticulitis               6                 9
Dermatitis herpetiformis     4                 5
Other                       36                39

More complete results were published in their Spring 1993 newsletter.
Reprints available from:

 Canadian Celiac Association
 6519B Mississauga Road
 Mississauga, Ontario L5N 1A6

 (416) 567-7195  (800-363-7296 in Canada)

In addition to the misdiagnoses above, gluten has been shown to aggrevate
the following conditions:

 autism
 asbergers
 attention deficit
 chronic fatigue syndrone
 fibromyalgia
 schizophrenia
 diabetes
 anorexia

If the HMOs could identify and support all of their gluten intolerant
members, the savings to them could be absolutely enormous!!

Don Wiss.