Thursday, November 11, 2010

Debunking a Definition

The Cure.

I'd think this post would be so much easier if it was about the alternative rock band known as The Cure - you know, the English guys with hits like "Lovesong," "Just Like Heaven," and "It's Friday, I'm In Love" that have musically thrived worldwide since the late 70s.

But that's not the tune I'm singing about here today. And there's the warning. Leave all weapons at the subject line, please.

As a community, we People With Diabetes strive to debunk myths and stop the misconceptions so often thrown around in the general public and even within the established medical community. We want to Stop Diabetes (per the American Diabetes Association's campaign with this name), eliminate it, "cure" it as organizations such as the Juvenile Diabetes Research Foundation and Diabetes Research Institute advocate.

In reading many of the D-Blog Day posts recently, I found myself in a discussion about how many of us PWD talk of our hope for a cure, but at the same time say we aren't going to base our lives on that hope that simply might never be realized in our own lives. Instead, we embrace (as much as possible) the modern medicine, technology and tools that allow us to live successful, productive, happy lives. That management is very important to us, but we don't see it as "a cure." We recognize that insulin, CGMs, and possibly even something such as the Artificial Pancreas might be as close as we're going to get to keeping diabetes at bay. That furthered a point from my discussion-mate: some holding those views may see those "treatments" as a form of a cure.

I wholeheartedly disagreed, arguing the difference between "treatment" and a "cure."

"That's just not right, because it's not what the word 'cure' means," I contended with confidence.

"But some may view it that way," came the response.

With that, we turned to the handheld American Heritage Dictionary from 1994 for guidance. According to the definition, a "cure" is defined as:

1. Restoration of health. 2. A method or course of treatment. 3. An agent, such as a drug, that restores health.


The definition of this word "cure" isn't to be confused with a "cure-all" - or something that cures all diseases or evils.

I re-read it, trying to get my mind around what it was actually telling me. My reading of that text told me that a "cure" is either 1, or 2, or 3. Possibly all three, but that it didn't have to encompass each of those three components. One would suffice.

So, using a strict contextual interpretation, then that definition of a "cure" could be translated to say: Insulin IS a cure because it's a method or course of treatment. It does restore health to a point.

Yes, I said it. And not believing what had just sprinted across my mind, I felt like punching myself in the face. A pesky inner-voice heckled me: "Well, crap. You're wrong. That's not what you've ALWAYS thought to be a cure. And double-crap. The DOC really is not going to like this..."

"You're telling me..." I whispered to myself, fully aware of the self-conversation playing out in my head.

My mind flashed to the JDRF and DRI, which advocate so much for a "cure" to diabetes. And how so many of us urge people to realize that insulin isn't a cure, that it's only life-support until we find a way to prevent it or eliminate it completely once it bears its ugly face.

I turned to another dictionary, hoping that my now-16-year old pocket dictionary was somehow outdated or mistaken. In the Stedman's Concise Medical Dictionary For the Health Profession (3rd Edition from 1997), the definition states: "1. To heal; to make well. 2. A restoration to health. 3. A special method or course of treatment. [From the Latin curo, meaning to care for]."

The thick, comprehensive table-top dictionary at my office that weighs too much made a point to add in the provision that a cure is a treatment "without implication of result."

Well, then.

Turning to some medically-hip members of the DOC, I sought further guidance on this topic. A fellow Type 1 studying medicine at Indiana University and about ready to leave for medical school came to my aid. Alyssa (The Chocolate Cheerio) relayed that the 1982 Stedman's offered a similiar definition, and that the 1925-version (a few years after insulin's discovery) revealed it was dubbed "the act or art of healing; a remedy; to heal; to restore to health."

My Roget's 21st Century Thesaurus from a decade ago said a cure is a "solution to problem, often health," but if offered me alternatives: aid, alleviation, antidote, assistance, catholicon, corrective, counter-measure, drug, elixir, fix, healing agent, medication, panacea, quick fix* (no, I didn't add the star there), remedy, treatment."

Basically, this all told me that definitions are somewhat fluid and that our society and Diabetes Community has essentially modified the definition of "cure" for diabetes to be that "cure-all." That it's the end-all, be all destruction of this disease that disrupts our pancreases.

But when it comes down to the actual word's meaning, we'd lose in court. The definition is clearly outlined in multiple places to mean exactly what we advocate it doesn't mean.

Just as insulin can be seen as a cure by one part of the definition, it doesn't fit when looking only at the other possible meanings. But that doesn't matter. It's not a three-part requirement - one part met means you're correct.

Now, I don't want doctor's promising the end of something when that's not the case. I do not want False Prophets coming along trying to sell their snake oil to vulnerable people who just want that tangible "cure." Those types are already out there doing damage. Drew Carey and Halle Berry come to mind, as two high-profile people who claim to "cured" themselves of diabetes - the latter saying she's weaned herself off insulin. I worry what happens if people see insulin, or low-carb diets, or snake oil of any kind, as a "cure" and then put themselves or someone else in danger as a result of following that as gospel that it'll fix everything for good.

So, after all this, what do I think a cure is? The same as before. While insulin or any device may make life easier and treat diabetes, it doesn't do away with it completely. That's what I want: a total end to diabetes for everyone. A cure-all. Not a treatment. Words may allow for some to see insulin as a form of a cure, but I find fault with that reading - even if it is technically accurate by the dictionary's definition.

Insulin may be a cure to stopping the kind of life that was basically a death sentence prior to 1921, and our research and technological advances may be ways to cure the way we all once lived with diabetes during the Dark Ages. But none of these things are a cure-all, and they certainly aren't The Cure as we know and believe it to be.

I prefer to think of insulin as Ginger Viera so awesomely dubs in her recent video: "Insulin is NOT a cure, it's like duct tape." I really like that.

Of course, whatever one's version of The Cure may be, here's to the hope that we can find something that is "Just Like Heaven" in however we need it to be.


Briley said...

We'll just have to start calling it Cure1

Also, I bet those families in the 1920s viewed it as a cure and who can blame them? Since we've been living with this "cure" for 90 years, we just don't see it that way anymore because it's all we know. And I think too, more reason to watch Big Blue Test video, we'll be giving them Cure2!

Wendy said...

AWESOME POST! Thank you for this insight...good stuff to think about!

Allison Blass said...

OK, let's break that definition down, shall we?

1. Restoration of health.

Insulin did not restore my health completely. I am still at risk for blindness, kidney failure, stroke, heart disease, amputations, and dead-in-bed syndrome because I have diabetes. Insulin merely mitigates these risks, but it has not fully restored my "health" because if it did, these complications would not longer exist.

2. A method or course of treatment.

Cures are often prescribed as a "treatment," because that's how you administer them in a hospital-setting. An islet cell transplant is a "treatment" or "procedure" for a cure of diabetes, but insulin is not. An islet cell transplant is a one-shot deal, but insulin is not. The fact that insulin never stops means it is not a cure. It is just a treatment, not a cure.

3. An agent, such as a drug, that restores health.

Again, this isn't what insulin is. Insulin keeps us alive, but it doesn't restore perfect health. If it did restore perfect health, we would not have to test our blood sugar, count carbohydrates, worry about complications. If I could take one shot or a series of shots (a series that ENDED - not perpetually given) that meant I didn't have to do anything I currently do to manage my diabetes, then yes, that drug would cure me.

Really, it all comes down to what you think "health" is. If "health" means "to be alive," then yes, I guess insulin is a cure because I'm not dead. Many people would say that the fact we are still at risk for *worsening* health means that, no, we're not cured. Insulin is not designed to restore health to perfection, it merely keeps you from getting worse.

Scott Strange said...

Great post Mike, I think that it is important to have a discussion on this topice

Tho, as I was reading it, the little voice in the back of my head was going "Mike's gonna get in trouble" LOL

Michael Hoskins said...

Allison: I'm 100% on the same page as you are. I'm happy to be alive thanks to insulin, but I don't see myself as "cured" so to speak. But while we all interpret the reading that way, insulin is in fact "a method or course of treatment" and a strict reading without interpretation puts that into the definition of a cure. By that wording, it doesn't classify that said treatment must "be permanent" or "completely restore to original health." Not that I agree that it should be read that way, but it is what it is. That's my point.

Meri said...

No offense to Mr. Webster or whoever else writes those dictionaries...but I think our definition would win in court. I'm sure you could provide proof, beyone a resonable doubt that the majority of the population views "a cure" as the end all.

And I REALLY like Allison's definitions!

eb said...

OK OK it's LOTS better than it used to be (Lantus, Levemir, Humalog , Pumps, teeny-weeny needles, Jonas brothers commercials, etc) but to me insulin is sort of like a really...long...drawnout.....treatment option, and it takes discipline and persistence to make it really work well.
Nuh-uh ... to this PWD, CURE means saying "I used to be a PWD" or even better NEVER having to say it.
It also means that complications would be a non-issue, a thing of the past.

Cure 1.0.....many more and better updates and revisions needed. I'll be here waiting


Jonah said...

Insulin is a cure for the disease the word diabetes was for: a disease where you piss away your life in sugar you can't use.

Insulin is not a cure for the disease we live: a disease where we may go dangerously low, where we develop diseases of all parts of the body at a scary rate.

There's a great youtube video, the discovery of insulin, and there's a line "It's a different world/ because of the cure that we've unfurled" and I agree wholeheartedly with that statement.

The word verification for this comment is oddly apt: diaquast.

The Chocolate Cheerio said...

The logistics of what a cure actually is can be argued, but at the end of the day, this post made me thankful. When insulin was first discovered, it was seen as a life-saving agent. It was a form of cure, because it saved lives that would've formerly been lost. How lucky I am to live in an age where it's actually feasible to live to dream of an even better cure.