Bittersweet: Diabetes, Insulin, and the Transformation of Illness [Hardcover]

Chris Feudtner (Author)

Book Description

ISBN-10: 0807827916 | ISBN-13: 978-0807827918 | Publication Date: May 26, 2003 | Edition: 1

One of medicine's most remarkable therapeutic triumphs was the discovery of insulin in 1921. The drug produced astonishing results, rescuing children and adults from the deadly grip of diabetes. But as Chris Feudtner demonstrates, the subsequent transformation of the disease from a fatal condition into a chronic illness is a story of success tinged with irony, a revealing saga that illuminates the complex human consequences of medical intervention.

Bittersweet chronicles this history of diabetes through the compelling perspectives of people who lived with this disease. Drawing on a remarkable body of letters exchanged between patients or their parents and Dr. Elliot P. Joslin and the staff of physicians at his famed Boston clinic, Feudtner examines the experience of living with diabetes across the twentieth century, highlighting changes in treatment and their profound effects on patients' lives. Although focused on juvenile-onset, or Type 1, diabetes, the themes explored in Bittersweet have implications for our understanding of adult-onset, or Type 2, diabetes, as well as a host of other diseases that, thanks to drugs or medical advances, are being transformed from acute to chronic conditions. Indeed, the tale of diabetes in the post-insulin era provides an ideal opportunity for exploring the larger questions of how medicine changes our lives.

Editorial Reviews

From The New England Journal of Medicine

What has been the impact of medical care on health over time? To answer that long-standing and still troubling question, Chris Feudtner has given us a term to use: bittersweet. Examining the history of insulin therapy, Feudtner describes what he calls the transformation of illness. The idea is simple enough, though it has not been stated so clearly and compellingly before now. Marvelous new therapeutic techniques often do not conquer or eradicate diseases but, instead, transform them. The introduction of insulin in 1922 transformed the acute, rapidly fatal course of a diabetic coma into a chronic illness that could be monitored and managed over the years. As a historian and a pediatrician, Feudtner is sensitive to the ironies implicit in insulin therapy. This treatment often stopped cold the ravages of ketoacidosis yet created in its wake a host of late complications in the vessels of the retina, brain, heart, and kidneys of patients with diabetes. The transformation of disease, as exemplified by the case of diabetes, is a valuable and elegant concept that serves to remind us that the tally sheet for medical science must carry a column for debit as well as credit. Feudtner builds on a meticulous examination of the clinical records and correspondence from the clinic of the famous Boston physician Elliott Joslin to chart the effects of insulin therapy on the physicians and patients who pioneered it. The sections about the patients who first encountered insulin are fascinating. What did this miracle drug mean for medical care? The records that Feudtner studied contain the lengthy correspondence of Joslin's original patients, who reported their successes and tribulations in using insulin. The treatment of diabetes allowed patients to be involved in the day-to-day technical control of a disease in a way that was unprecedented. Feudtner has carefully sorted through the documents of a first generation of patients who entered this regimen of regular injections, sugar monitoring, and dose adjustments. He notes that we find in these letters not private reflections on illness by its sufferers but something more selective. These people were writing to their doctor. They tailored their observations and reports carefully, needful in turn of the advice, attentiveness, skill, or sympathies of a physician. One especially poignant example is Guy Rainsford, who kept up a decades-long correspondence with Joslin and illustrated his medical concerns in part through a series of penciled cartoons. Rainsford's sketches featured himself as the quirky and irascible protagonist of an ongoing struggle against his ailing body, armed with, or beset by, a sometimes bewildering array of syringes, retorts, chemicals, and charts with which to manage his sugars. Insulin transformed the illnesses and the lives of the patients who came under its influence. The new drug equally transformed the outlook of the physicians who first prescribed it, as Feudtner compellingly shows. Insulin seemed surprisingly to make the smallest difference in the basic goals and constraints of daily medical practice. Early proponents of insulin treatment, like Joslin, recognized that they were at the cusp of a new era. Yet physicians carried over into this era many characteristics of their earlier regimens of treatment. The sections of the book about the treatment of childhood diabetes before 1922 are wonderfully informative. Treatment through aggressive dietary restrictions before the introduction of insulin manifested strikingly similar patterns of management. Frequent assays of urinary sugars guided vigilant attention to sugars and fats in the diet. Similar issues about the ability to comply with the rigors of medical advice arose in dietary treatments, so that similar themes emerged in the relationships between physicians and patients before and after insulin. What changed most were the expectations of success. The limitations of insulin treatment were evident in Joslin's day, as they are now, but they must have seemed negligible as compared with the hazards and torments of diabetes before 1922. Bittersweet brings us a telling account of what this transformation in medicine entailed. Christopher Crenner, M.D., Ph.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Review

"A consummate study in irony, in the classical sense of the dramatic unfolding of tragic consequences from apparently benign events."
— British Journal for the History of Science

See all Editorial Reviews

Product Details

• Hardcover: 312 pages
• Publisher: The University of North Carolina Press; 1 edition (May 26, 2003)
• Language: English
• ISBN-10: 0807827916
• ISBN-13: 978-0807827918
• Product Dimensions: 9.6 x 6.4 x 1 inches
• Shipping Weight: 1.4 pounds (View shipping rates and policies)
• Average Customer Review: 5.0 out of 5 stars  See all reviews (1 customer review)
• Amazon Best Sellers Rank: #1,055,028 in Books (See Top 100 in Books)

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13 of 14 people found the following review helpful:

5.0 out of 5 stars A great book for medical and non-medical readers, March 8, 2004

By A Customer

This review is from: Bittersweet: Diabetes, Insulin, and the Transformation of Illness (Hardcover)

This book describes the transformation of diabetes from a rapidly-fatal illness to a chronic one with a host of new associated problems. Though written by a physician, the book focuses on this transformation from patients' perspectives. In addition, it emphasizes the impact of diabetes on not just the health of individuals but also on their day-to-day lives.

The highlight of this book is the collection of stories of individual patients and families. Drawing from letters and other patient records at the Joslin Diabetes Center in Boston, Feudtner vividly details the lives of diabetic patients in the 20th century. Of particular interest is a patient who corresponds with his physicians using self-drawn cartoons, a number of which are included in the book.

While this book will be of special interest to diabetic patients and physicians, I recommend it to any reader intersted in the interplay between modern medicine and the people it aims to serve.