Cheating Destiny: Living With Diabetes, America's Biggest Epidemic (Hardcover)

by James S. Hirsch (Author)
Key Phrases: diabetic utopia, islet cell transplants, normal glycemia, Elliott Joslin, New York, United States (more...)

Editorial Reviews

From Publishers Weekly
Hirsch, a type 1 diabetic, agonized when his three-year-old son began exhibiting the symptoms of diabetes. More, he was prompted to take a look at diabetes and how it is treated in this country and the possibility of finding a cure for this ravaging disease. What he finds isn't always encouraging. Skillfully combining journalistic expertise with his personal story, Hirsch, a former reporter for the New York Times and the Wall Street Journal (Hurricane: Riot and Remembrance) asks the editor of a hugely popular Web site about the quality of care for diabetes in this country. The response: "It stinks." Hirsch details the physical complications that arise for insulin-dependent type 1 diabetics and health insurers' reluctance to fully reimburse relatively low-cost education for diabetics, resulting in their need for high-cost diagnostic testing and hospital care. Some of Hirsch's reporting uncovers a common blame-the-patient attitude in doctors. The author also covers the controversial studies of Denise Faustman, whose groundbreaking research has produced promising results in mice, and the stem-cell research of Douglas Melton. Overall, this is an informative and moving analysis of a disease with a death rate that, high as it is, the author says is underreported. 16 pages of b&w photos. (Nov. 8)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From The Washington Post
Reviewed by Sara Sklaroff Why is there still no cure for diabetes? James S. Hirsch has every right to ask. He's lived with the disease since he was 15; his brother, who was diagnosed at 6, is now a nationally prominent diabetes doctor. And in the course of researching Cheating Destiny, his new book on the subject, Hirsch learned that his young son has diabetes, too. He knows what lies in the boy's future: a lifetime of finger pricks, insulin injections -- and the hovering specter of disability and early death. It is a desperate thing for a father to contemplate, but it gives a powerful emotional drive to this insightful, deeply reported book.

By now, the facts are nearly boilerplate: Diabetes is epidemic in America, affecting about a 10th of the population and rising; its costs in health care and related expenses are measured in the billions of dollars. Minority groups develop diabetes at above-average rates, and now more and more young people are showing up with what used to be called the "adult" form, type 2. (Although Hirsch and his family members have the less common type 1, in which the body has completely lost the ability to make its own insulin, he is just as clued in to the "insidious" type 2, in which the body's production and use of insulin are impaired.) Tens of thousands of diabetics are still undiagnosed; few of those who do know they have the disease get good treatment.

Tough stats, but they don't say much about what it's like to live with diabetes and the roller-coaster of blood-sugar highs and lows, the daily calculations of what and how and when to eat, the constant, exhausting vigilance. Hirsch, a former reporter for the Wall Street Journal and the New York Times, understands all that, down to the most mundane details. I used to be proud of my talent for shooting insulin on the sly in the middle of a busy Starbucks -- until I read about what Hirsch did in Times Square. He was looking for a place where he could inject, and no restaurant would let him use a bathroom without buying a meal. So he ended up taking a peep-show booth, filling his syringe as a stripper gyrated on the other side of the glass.

More harrowing is the chapter about the time Hirsch miscalculated the balance between his insulin and his food intake, sending his blood sugar plummeting. Dazed, he got into his car anyway -- and wound up driving himself and his son off the highway and into a ditch. (Neither of them was seriously injured.) This is a guy who is as well-informed about diabetes as a layperson can be, who is lucky enough to have access to the nation's best doctors -- but even he stumbled. Do the rest of us even have a chance?

Hirsch thinks so: While some health experts say that the kind of behavior modification necessary to fight the disease is "too elusive and too difficult to translate to the masses," he believes that "most diabetics, given the tools and training, are willing to discipline themselves to stay healthy."

And yet diabetes is particularly -- perhaps uniquely -- unsuited to the way medicine is practiced and paid for in America. Ideally, most patients would receive intensive and ongoing education in addition to regular monitoring and testing by a team of health professionals working in concert. Good luck making that happen. Our medical system has evolved to treat sudden or episodic illnesses, not chronic ones. Hirsch describes the perverse incentives and shortsightedness that drive health insurance companies to cover, for example, leg amputation, but not the care and education that would have saved the leg in the first place.

Through nuanced profiles of patients, doctors, researchers and activists, Hirsch persuasively illustrates an epidemic that is at odds with modern society at almost every level. While technology has brought us such remarkable advances as the home blood-glucose meter, with superfast results that allow the fine-tuning of treatment, those high-tech promises come with frustrations, too, such as hypersensitive meters that regularly give faulty numbers.

Meanwhile, not only is public funding pitifully low for both research and treatment, but the way research is financed in this country discourages the kind of out-of-the-box thinking that some experts believe might lead to a cure. Hirsch also raises the disturbing possibility that the $132 billion-plus diabetes industry may have little incentive to find one.

But the blame rests elsewhere, too. Patients and doctors have become too complacent, Hirsch says, accepting halfway measures because eradicating the disease seems like a fantasy. Parents of children with type 1 diabetes have long been active advocates for research, but too many people with type 2 are absent from the fight, ducking their heads in guilt because they believe the illness is their fault: a result of moral weakness and lack of willpower. It's the same emotional bind that inhibits many from managing their condition. Now Hirsch has written the book that people who care about diabetes have been waiting for. If it spurs more of us to work for a cure, so much the better.

Reviewed by Sara Sklaroff
Copyright 2007, The Washington Post. All Rights Reserved.

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Product Details

• Hardcover: 320 pages
• Publisher: Houghton Mifflin Harcourt; 1 edition (November 8, 2006)
• Language: English
• ISBN-10: 0618514619
• ISBN-13: 978-0618514618
• Product Dimensions: 9 x 6.3 x 1.1 inches
• Shipping Weight: 1.2 pounds (View shipping rates and policies)
• Average Customer Review: 4.0 out of 5 stars See all reviews (20 customer reviews)
• Amazon.com Sales Rank: #115,477 in Books (See Bestsellers in Books)

Customer Reviews

Most Helpful Customer Reviews

16 of 16 people found the following review helpful:

4.0 out of 5 stars Looking and past mistakes and hoping for a better future, January 2, 2007

By	Bernard Farrell (North of Boston, MA USA) - See all my reviews (REAL NAME)

Let me start by saying that if you're new to diabetes, this book is probably not for you.

Mostly this is because of the book's coverage of the recent history of diabetes treatment and all of the shortcomings. In the early part of the 20th century the hope of insulin followed by the realization of the complications caused by living with elevated blood sugars.

Hirsch has a lot to say about what's gone wrong in the past and in the present day. This includes the lack of coverage for proper diabetes care and the ongoing promise of 'a cure' in the near term. And he also has some eye-opening statistics about the cost of diabetes care and complications.

But readers might also be dismayed by the immediate future for diabetes. The author covers some of the research that's happening towards such a cure, without being unrealistic about the likelihood that positive results will occur any time soon (my personal bet is that we won't see anything significant before 2015).

I just wish that he had laid out a plan for how things might be made better. I know that in the end this would just be one person's opinion, but having a chapter entitled something like "Effectively Dealing with Diabetes until We See a Cure", where he made specific proposals such as how healthcare and research dollars might be best spent, would have made this a much more worthwhile read.

My one hope is that if enough people read this book they might start to talk with their legislators. Then maybe diabetes care and research might be handled in a way that would improve the quality of life for those with the disease now, and would yield significant health care savings for all of us along the way.

11 of 11 people found the following review helpful:

5.0 out of 5 stars Excellent Reading for Diabetics or people that live with or love Diabetics, January 9, 2007

By	L. Heffelfinger (Ohio) - See all my reviews (REAL NAME)

This book has the passion and the feeling of how Diabetes affects every part of your life. The author is knowlegdable and has lived through what most diabetics have. The book has many facts that I did not know and the stories bring the book home to every reader. If you live with or love someone with the disease you should read this book. The author shows the struggles of everyday living with the disease and also the succeses. Great book with wonderful stories that can be felt by each reader.

10 of 10 people found the following review helpful:

4.0 out of 5 stars Great book, January 9, 2007

By	orpament II "Newberry Award Reader" (Northampton, MA USA) - See all my reviews

I agree with those who thought this was a really good book. I've read Bernstein's book as well. I'm not sure why someone would think this is a book on diabetes treatment. It's a personal account with some historical, scientific stuff thrown in. Personally, I found it really fascinating and kind of comforting. As a diabetic, I've known that we really are on our own with only other diabetics to relate to. I think this author relays this well.

As for Bernstein, I'm actually following a lot of his advice, and, yes, I have seen improvement. But keep in mind, Bernstein's approach is rigorous and one of extreme denial of food, and extreme rigidity and control. His approach remains controversial. Not everyone can live like that. Part of the human existence is enjoying life, and food is a very important part of that. I can't imagine expecting a child to adhere to Bernstein's rigorous program.

Do read this book if you are a diabetic. It is not a manual for treating diabetes.