Diabetes

“Yet, the diabetic situation after insulin was rather more complicated – a ‘terrible beauty’ had been born. While the insulin developed by Banting, Best, Collip, and Macleod during 1921 and 1922 warded off coma and proved to be a tremendous boon to diabetics, the disease nevertheless remains a scourge, currently causing more renal failure, amputations of lower extremities, and blindness among adult Americans than any other disease. Defying any simple synopsis, the metamorphosis of diabetes wrought by insulin, like a Greek myth of rebirth turned ironic and macabre, has led patients to fates both blessed and baleful. . . . Unlike the concept of a stable and preordained natural history, the notion of transmuted diseases stresses both the malleability of disease entities and the role of human choice: chronic diseases manifest themselves in a particular patient according to the combined effects of physiological processes and human interventions . . . . Indeed, as diabetes has been diverted further and further away from its natural course, the very notion that this disease has an underlying natural history has become outmoded – clearly, a new paradigm of cyclic disease transmutation has taken hold. . . . just as the miraculous therapy of insulin has allowed long-term problems to emerge, other dreams of therapeutic success are also likely to find themselves mired in iatrogenic irony, with complete success proving to be complex and elusive” (Feudtner, 36, 37, 40, 41) Cf. cystic fibrosis (CF) as “transmuted disease”: “Yet the advances always seemed to be mixed blessings, ushering in new challenges such as antibiotic-resistant organisms or extensive after-transplant health problems. . . . From the outset antibacterial therapy was a balancing act for the clinician  alternating drug regimen in late-1970s [cf. TB], and clinical research to regulate use of innovative drugs (Wailoo III, 80-83). From mid-1980s, lung transplantation further reinvented cystic fibrosis as a pulmonary disease, since increasingly older (= into young adulthood) patients increasingly died from lung problems, with surgery  further transmutation of CF owing to lifelong posttransplant care: “Having a transplant is a chronic illness” (surgeon Thomas Spray, in Wailoo III, 89). Cf. also sickle cell disease, where, in the 1980s, bone marrow transplants “amounted to the replacement of one chronic condition (SCD) with another (GVHD) [graft-versus-host disease] (Wailoo III, 148-149) = “trading one disease for another” (151).