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Books, Journals, New Media
February 11, 2004

Diabetes, Medical History

Author Affiliations

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.

JAMA. 2004;291(6):745. doi:10.1001/jama.291.6.745

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.