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Cure

Cure.

There are days when I wonder why illness befalls us. Not the common colds, sore throats and ear aches, but the devastating diseases that cripple and destroy our lives. More importantly, I wonder why the search for a cure for these devastating sicknesses is marketed nationally by foundations dedicated to a particular illness, however the only treatments that are being produced are maintenance therapies, not cures. So what would it take to cure a disease?

The word cure is an interesting one. As a verb: cure can mean to relieve (a person or animal) of the symptoms of a disease or condition; He was cured of the disease. Certainly the words heal, restore to health, make well/better come to mind. Cure can also mean to eliminate a disease, condition or injury. All too often we hear the words, This technology could be used to cure diabetes. It also means to solve a problem; stopping foreign investment is no way to cure the fundamental problem of economic inequality or economic equality cannot cure all social ills. It also means to preserve meat, fish, tobacco or an animal skin by various methods such as salting, drying or smoking. We have all eaten cured bacon. A third meaning means to harden after manufacture by a chemical process such as vulcanization or a chemical process (rubber, concrete, plastic, etc.).

As a noun, cure means a substance or treatment that cures a disease or condition depending on the verb one is referring to; The search for a cure to the common cold. Does that mean we are actually trying to eradicate the common cold or just looking for ways to reduce the symptoms of a cold? I have no idea what the phrase actually means and I am a physician. Cure could also mean a restoration to health or a solution to a problem; the cure to our sluggish economic growth it to provide tax cuts to the uber-rich. The bottom line: cure is an interesting concept.

So what do most medically-oriented, disease-curing companies and foundations mean when they are espousing the idea that they are searching for the cure? I have some thoughts.

During the past thirty years practicing medicine, I have yet to see a cure or total eradication of any disease that was brought about by the actions of physicians and/or large research agendas. I have seen treatments that have made patients symptom free or placed their disease in remission, but not cured if I refer to the term meaning eradicate. A great example was my recent encounter with a sixty-five year-old male patient who had been treated for prostate cancer. He underwent robotic surgery to remove his prostate. The cancer was totally contained within his prostate, the malignancy had not penetrated the outer capsular membrane of the gland. His urologist told him he was cured. However, when he asked about testosterone supplementation, the urologist told him that if he used testosterone replacement therapy, the cancer could come back. His surgeon refused to allow him to take testosterone in any form whatsoever. When I called the urologist and posed the question that if he was cured from prostate cancer, how would giving him testosterone create another separate prostate cancer in his body, assuming all of his cancer was contained in the prostate and his entire prostate was removed.

The urologist just bristled and said that the standard of care was to discontinue all testosterone supplementation after surgical removal of his prostate because the hormone could potentially stimulate prostate tissue to grow and his cancer could spread. He loudly professed that he removed his entire prostate, and he did not think there was any prostate tissue left behind. But to be safe, he would absolutely disapprove of any testosterone treatment. When I asked the urologist if he had ever read an article linking testosterone to prostate cancer, he said no. I recognized his narrow worldview as he summed up his thoughts, I am just being safe. So was the man cured of prostate cancer or not?

When I was in medical school, we commonly prescribed pork insulin to diabetic patients. Human insulin was not available in the late seventies. Patients developed all kinds of reactions to the pork insulin, but it was the only medication we had at that time. I vividly remember a hardy marketing campaign by a large, powerful drug company after they had manufactured human insulin from genetically modified bacterial fermentation. They had found the cure for diabetes: just use human insulin instead of pork insulin and the diabetic patient would be cured. I hold the opinion that using human insulin is much better than pork insulin. The drug company did not cure insulin dependent diabetes mellitus, regardless of their clinical research and marketing strategy. Currently several investigators believe that the majority of the medical complications in an insulin dependent diabetic patient are most likely due to the excess insulin patients use to control their blood sugars. However large definitive studies have not been executed to prove their theory.

If it were proven that excess usage of human insulin was causing significant morbidity and mortality in patients afflicted by insulin dependent diabetes mellitus, what do you think would happen to the pharmaceutical companies? How would insulin dosage change as a result of the data? I hope you recognize the answer: The cure ultimately becomes the disease. The cure for diabetes mellitus is to stop ingesting all forms of sugar, especially carbohydrates in the forms of grains, fruits, beans, and dairy. But if nutritional modification would almost cure insulin dependent diabetes mellitus and is much safer, why not pursue that course of treatment instead of hyper-medicating and over dosing human insulin? Just think about the lack of research in celiac sprue in the United States, the disease of gluten induced malabsorption syndrome. The disease is cured when an afflicted patient stops eating gluten in any form. Simple. How much money can be made in the pharmaceutical business by not eating wheat? None at all. How much money is lost if people stopped eating wheat in our society? Plenty.

Curing illness has become a banner of altruism in marketing today. I do not know of a color that has not been adopted by some medical foundation dedicated to the cure of some disease or a company that has refused to join-in-the-fight of some popular illness because doing so attracts faithful consumers (who support the fight for the cure of the disease the company adopted) to their over priced products and services. We seldom hear of a cure emerging from the research money raised by any medical foundation nor do we have any public understanding as to how those foundations release their dollars to medical research facilities, universities, victims of the disease or hospitals. However, research facilities and for-profit companies are growing in their support for the cure of all kinds of illnesses. I am not aware of any company raising the banner against celiac sprue.

I think I know what cure means to almost all of the various institutions involved in finding the cure of a disease. One, is that it allows them to fund raise and create revenue. Two, the cure does not mean eradication of a disease; it means long term management. Long term management creates a huge amount of revenue for physicians, hospitals, pharmaceutical companies, high-tech companies, drug stores, clinical laboratories and a plethora of niche businesses in between. So I guess, if you're in a race for the cure or running for the cure make sure the foundation and what cause they support is actually not running from the cure, the eradication of the disease.

If they are dedicated to running for the cure which means research for long term disease management, find another race!

Doc

Posted by Amanda Sanders at 9:50 AM
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