When I was first diagnosed with diabetes, the Harvard Professor of Endocrinology who was teaching my class on managing diabetes for new patients at the Joslin Clinic in Boston commented that the disease “was long overdue for a cure.” Unfortunately, that was 1966, and we still have no cure, and now the usual propaganda about a cure becoming available in “five to ten years” has changed to twenty-five years and more. Why has progress been so slow?
In part this is because of the general stagnation in medical progress in recent years, with the last major disease having been overcome in 1954, when the polio vaccine was discovered. Many respected commentators have discussed this slow-down, including Eileen Crimmins and Hiram Beltran-Sanchez, Tyler Cowen, James Le Fanu, Megan McArdle, and James Vaupel. The slowing of new drugs submitted for FDA approval for the first time ever in 2008 is a measure of this stagnation. This may be part of a wider phenomenon noted by Michael Hanlon, which is that scientific and technical progress are generally slowing in all fields of science, such that an 80-year-old in 1960 would have seen the invention of cars, telephones, televisions, radios, movies, antibiotics, x-rays, satellites, rockets, jets, radar, cures for tuberculosis, numerous vaccines, and endocrine deficiency supplement treatments, an 80-year-old in 2010 would only additionally seen the development of space travel, cellphones, computers, and the internet.
One way to explain this is to note that the low-hanging fruit is easiest to pick, and the problems of further development at the frontier of knowledge may take a lot more investment of time and money to solve.
Another problem is that medicine is glacially slow in its progress, partially because it is not just a science but also a professional, and professionals can only enforce the boundary against non-professionals if they maintain a firm commitment to existing knowledge and resist innovation. It is also hesitant and conservative in its reasoning and inference, in a way which would be shocking in other fields, such as physics, where a single key experiment can change an entire explanatory paradigm and start a revolution in thinking, while the first instinct of medical researchers when confronted by a novel theory or datum is always to try to explain it away as based on a flawed study or as too new for people to trust it. I tried, for example, for a paper for a history of medicine course I was taking, to trace the development of theory in an area of medicine over the previous 40 years, and I found I could hardly tell whether I was reading a journal article from 1980 or from 2010, since medical researchers had just been chewing over the same old ideas without an inch of progress in all those years.
The slowness of progress in type 1 diabetes might be due to limited financial returns for finding a cure, since any pharmaceutical company also raking in the profits from massively overprices diabetes management tools would have to discount the value of any cure by the loss in selling these accessories for an incurable disease. A lot of time and money are wasted, at least from the perspective of people with existing cases of diabetes, by the considerable research effort devoted to preventing the onset of type 1 diabetes rather than curing it. Considerable research energies are consumed by efforts to improve management tools rather than to find a cure. Many efforts are wasted on utterly dead avenues of research, which the briefest initial consideration would reveal as pointless, such as searching for cures for type 1 diabetes which involve taking immunosuppressive drugs whose side-effects are worse than uncontrolled diabetes, so what is the point even if they work? Public support for type 1 diabetes research is undermined by the general public assumption that if all diabetics would only get off the couch and stop eating so much, the disease would go away. Many diabetes cure organizations spend massive amounts of money on executive salaries (e. g., one CEO earns more than $800,000 a year), as well as on administrative costs and advertising, leaving only a tiny fraction of contribution funds available for cure research. The amount of money society spends on addressing the problem of diabetes is also miniscule compared to the financial and human costs of the disease. Finally, I can’t count the number of times I have read medical journal articles having absolutely nothing to do with a cure for the disease, and having a title like “Fingernail Growth as a Function of Uric Acid Levels in Newly-Diagnosed Diabetics,” and then at the end they acknowledge that the research in the article was funded by one of the many groups with a clear purpose of curing diabetes in their title!