Books, Journals, New Media Section Editor: Harriet
S. Meyer, MD, Contributing Editor, JAMA; David H. Morse, MS, University
of Southern California, Norris Medical Library, Journal Review Editor.
I really liked this book. Even for someone like me, who has devoted
much of a long professional life to the care of patients with diabetes, it
opened up new perspectives—not just about treatment of diabetes, but
about the care of everyone who is ill.
The author, Chris Feudtner, MD, PhD, MPH, practices pediatrics at the
Children's Hospital of Pennsylvania. He has built the book around the doctor-patient
and doctor-doctor correspondence found in the archives of the Joslin Diabetes
Center in Boston, Mass. Elliott Joslin, MD, graduated from Harvard Medical
School in 1895 and took up the specialized care of patients with diabetes.
This must have seemed to others a harrowing choice of career: the care of
patients with a then nearly universally fatal condition. But in 1922, having
watched more than 1000 patients die of their diabetes, Joslin saw the world
transformed by the isolation of insulin and its introduction into clinical
practice. Children who had been reduced to skin and bones by extreme calorie
restriction, the only treatment that even slightly slowed the headlong course
to death, were restored to seemingly robust health by insulin. But this achievement,
as the case records selected by Feudtner reveal, imposed new burdens on care:
the need for "control" of blood sugar and avoidance of dietary indiscretions;
the twin threats of ketoacidotic and hypoglycemic coma; the onset of kidney
failure, blindness, heart failure, and nerve damage. Thus the "victory" brought
by insulin was bittersweet. Feudtner as author is always explicitly in view,
speaking to readers, asking them to consider the price of "medical progress,"
the near and distant goals of treatment, the social and personal ramifications
of imposing the doctor's vision of the desirable upon the patient, and the
nature of cooperative interaction.
Neelon FA. Diabetes, Medical History. JAMA. 2004;291(6):745. doi:10.1001/jama.291.6.745