Needling diabetics

When the bubonic plague struck Europe in the fourteenth century, groups of penitents known as flagellants wandered the land scourging themselves in public. These groups, who were condemned by Pope Clement VI, hoped that their physical suffering and debasement would atone for the sins of the people that had led God to visit such devastating wrath upon them. It was a desperate, irrational act but then they were living in desperate, irrational times where the limits of knowledge meant that millions could die with little understanding of how or why.

Fast forward 700 or so years, taking in the Enlightenment and huge advances in scientific and medical knowledge, and you would think that the reaction of the educated elite to life-threatening illness would have lost the flagellation edge. You would hope that healthcare professionals would look to rational understanding to defeat physical threats to our lives and health. Not so. We have regressed in our relationship to illness, and the example of diabetes illustrates how we have lost faith in science to cure physical ailment.

To fess up at the start, I have a vested interest in this subject: I have been insulin dependent since 1976. I started ‘jacking up the big I’ when we still only had animal-derived insulin available, a discovery made by Frederick Banting’s Canadian team in 1924. Using laboratory dogs, insulin was isolated from pancreatic cells known as the Islets of Langerhans, at a time when belief in medical and scientific progress had not yet been diluted by the precautionary principle, scientific relativism and animal rights. Insulin has saved and continues to save millions of lives: without insulin, diabetics would be condemned to a medieval death, wasting away as their bodies fail to metabolise energy from food and they slowly become poisoned by sugar toxins (ketones).

There is something unique about diabetes: it is an incurable illness that can be controlled. It is a medical success story – perhaps one of the greatest of the twentieth century – that is now being treated as a modern plague, an out-of-control epidemic. For the very reason that diabetics no longer face certain death, it is one potentially fatal disease that public health campaigners, health journalists and anybody else can comment on with impunity. With a clear conscience, every health guru can take a good kick at the unhealthy, King Size Mars bars guzzling masses who are apparently asking for the wrath of diabetes to be visited upon them.

A thinly disguised paternalistic condemnation of underclass fat munchers breaks out when the ‘diabetes crisis’ (1) is publicly discussed. Ulster Unionist assembly member Billy Armstrong was in tub-thumping form when he declared ‘the diabetes epidemic must be addressed!’ and, citing concern about economic strain on the NHS, Billy issued dire warnings about the cost that diabetic slobs could inflict on society: ‘If the diabetes epidemic continues to rise, the losers will not simply be those who suffer the condition. All of us could be directly affected. Each of us [has] an obligation to encourage people to practise healthy living, both in dietary form and in physical exercise. If we do not, the prospects are too terrible to contemplate.’

Diabetes UK, a charity that has done much to support diabetics and their families, is not immune to the ‘brought it on themselves’ point of view. Diabetes UK national manager Delia Henry said: ‘We also know that because of lifestyle changes, people being overweight and not having as much activity in their life as they should have, that can be a trigger for diabetes. The combinations are not good for the future and we know that the number of people with diabetes will double.’ (2) A recent advert for the Juvenile Diabetes Research Foundation reads ‘Juvenile diabetes strikes our children at random. Let’s strike back’ (3). I’m all for striking back, but the first part of this well-meaning declaration is a serious misrepresentation of scientific fact.

Diabetes is not random, and juvenile diabetes is the least random of all. There are two types of diabetes, type 1 and type 2. Type 1 diabetes is early onset, and there is a considerable body of scientific research that shows a strong genetic predisposition to developing this sort of diabetes. Type 2 diabetes is late onset, and is thought to be associated with obesity in some cases.

At the heart of current representations of diabetes is a medical profession that has lost a sense of its duty to cure rather than chastise. When the medical profession turns to prevention instead of cure, the disease becomes fetishised around individual behaviour and experience rather than an understanding of the disease itself. The disease comes to define the person rather than being a physical obstacle to be overcome.

Even if there is a link between obesity and some forms of diabetes, shouldn’t we focus on cure rather than lecturing people about their lifestyle? Prevention is not better than cure: it is more often than not a copout.

There are many dedicated medical researchers and doctors determined to find a once-and-for-all cure for diabetes. The turning away from cure is something that has happened within a society that no longer believes in progress and in our ability to defy the odds with which we are born. It wasn’t always thus. In 1936, Frederick Banting wrote a gushing article in Canadian Business in praise of the scientific advances in the Soviet Union. If you ignore the starry-eyed salute to Stalinism, what is of value is his unswerving belief that scientific research is something that matters in a progressive society that cares for its people:

‘Man cannot exploit his fellow man…. The health of all is cared for by the state. All people have the opportunity to rise as high as their talent and industry will permit…. Her [the Soviet Union’s] future is doubly secure because no people in the world so fully realize that the science of today is the research of yesterday, and the research of today is the science of tomorrow.’ (4)

Politically naive, yes. But it is this belief in science and people that saved millions of lives: the belief that it was possible and that people were worth the effort.

Shirley Dent works for a research institute and is part of the team organising the Institute of Ideas conference ‘Health: An Unhealthy Obsession’, on Saturday 12 February at the Museum of London. For more information see the Institute of Ideas website.

(1) ‘Lack of focus’ on diabetes risks, BBC 10 November 2004

(2) Charity warns of diabetes epidemic, BBC News, 31 October 2001

(3) Third Sector Guide to Careers in Voluntary Organisations 2004/2005, p34

(4) Science and the Soviet Union, Sir Frederick Banting, 1936