Aside from things like lack of funding, what are some of the scientific/medical field obstacles? Are we just not at a high enough level of understanding? Does bioethics come into play anywhere? As a type 1 diabetic with some, albeit little, knowledge, I’m more than curious as to what’s stopping us!
First and foremost, largely the same people are in charge of finding a cure, that is, Big Pharma, as don’t want to find a cure, since they would destroy the highly profitable business of selling products to their captive market of diabetics. Every ad you see on tv for another diabetes trinket is another nail in the coffin of a cure. And of course, diabetics strengthen the locks on their prison every time they buy another of these products, even ones they don’t really need to, just because they become obsessed with the shiny gadgetry of it all.
Then there is also the fact that diabetes is, intrinsically, a complex disease, which is produced by a cluster of genes in both type 1 and type 2 patients, plus a variety of unknown or unavoidable environmental factors in both types of diabetes, in addition to a few additional known ones in type 2 diabetes, such as obesity and a sedentary lifestyle. But type 2 diabetes is more profoundly genetically conditioned than type 1 diabetes, and many are the thin and athletic type 2 diabetes who are newly diagnosed and wonder what happened. On the other hand, the fattest people on earth, the six hundred pound individuals who become confined to their beds, and not type 2 diabetics, so obesity’s relationship to type 2 diabetes is complex.
In both type 1 and type 2 diabetes, there is evidence of genetics playing a large role in the etiology of the characteristic complications of the disease, and in type 1 diabetes the continuing autoimmune attack on the body which initially destroyed the beta cells of the pancreas goes on to injure other parts of the body to add to the complications. Hyperglycemia is a third factor producing complications in diabetics, but why do hummingbirds live their whole lives with an average blood sugar six times that of humans and yet never develop any diabetic complications? So there are many targets that need to be attacked, but how these problems are caused is still not completely clear.
There are further mysteries in the fact that a small subgroup of diabetics appear to be immune from complications despite hyperglycemia, possibly because their DNA are resistant to its effects.
The third reason for the slow progress toward a cure is the general pattern of dithering, uncertainty, and lack of focus in medical research. A lot has been written about the stagnation of medical research during recent years, and some even say it started around 1984. The FDA published a panic bulletin in 2008 stating that for the first time in its history the number of new drug patent applications had declined, and many of the drugs seeking approval were just minor variations to escape existing patents. Because medicine lacks decisive experiments such as drive physics forward, since everyone always doubts the significance of any new result, suspecting it may arise from correlation rather than causality, it has to progress slowly, given that in biology all the extraneous variables can’t be eliminated. Also, since medicine is a profession, the established authorities in it are highly resistant to change, and naturally try to block the evolution of a field where they are the masters only if the knowledge they acquired decades ago remains relevant. Finally, medical research lacks organization, so the researchers work on the same problems in different parts of the world, mindlessly duplicating each other’s results, so there is a huge amount of waste. Extremely promising results also appear and lie fallow, since there is no organizational structure to notice, promote, and back them with financing. Again and again I have read medical journal articles that demonstrate genuine breakthroughs, only to find that they date from 1991 and nothing has ever been done with them since.
With a discipline like this, you could give medical science a sample doorknob and it would take them 20,000 years to discover how to open a door.
Until the cause, and the trigger are found there will be no cure.
We can transplant pancreases, in general, because the anti-rejection drugs make the cure worse than the disease. I kinda feel like we have a cure because we have insulin and such. Limitations there, I attribute to a lack of major advancements in mathematics. They are trying to overcome that with computing power.
I don’t think we necessarily need to find the cause before we can find the cure. Aspirin, for example, was successfully used in treating fever and aches for a century before the reason why it works was discovered in the late 1970s. If you count the use of the plant from which aspirin is derived, then the ‘cure’ for fevers and aches was applied for a thousand years before the medical reason why it should work was discovered. The same could be true for diabetes: we might never fully understand why it develops in all cases, but we might still be able to make it disappear, or replicate the action of a normal pancreas perfectly.