Book Review: Cheating Destiny – Living With Diabetes, America’s Biggest Epidemic

I read James Hirsch’s book in 2006 but never got around to reviewing it.  Better late than never?  I give it four stars per Amazon.com’s rating system: “I like it.”

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If you have diabetes or love someone who is afflicted by diabetes, you’ll benefit from this book. It’s an insider’s view into the world of diabetes, with a predominant focus on type 1 rather than type 2.  Both are covered well.

Look elsewhere for a “how-to” book on managing diabetes.  Cheating Destiny is about emotions, coping strategies, public policy, and history.  Although I’ve been treating diabetes for over two decades, Mr. Hirsch taught me a thing or two.  For instance, did you know . . . that some people with diabetes are offended if you call them diabetics? (They prefer “people with diabetes.”)  That diabetes was considered shameful years ago?  That even the preeminent Joslin Diabetes Clinic loses money and has to be supported by private donations?  That the founder of d-Life TV was a patient of the iconoclastic Dr. Richard Bernstein?  About the exciting story of the discovery of insulin by Fred Banting and Charles Best in 1922?   

The author himself has type 1 diabetes.  The heart-wrenching story of his son’s diagnosis at age 3 showcases Mr. Hirsch’s considerable writing skills. 

To counter the sad and frustrating aspects of diabetes, the book is peppered with  funny anecdotes.  Did you ever duck in to a private booth at a girlie peep show to inject insulin?  Mr. Hirsch has!  [It’s not what you think.]

One undercurrent of the book I take issue with is the implication that the medical profession somehow perpetuates diabetes or purposefully provides inadequate care, because that’s where the money is.  Why work hard to cure diabetes or prevent complications when the profession makes money off the disease and it’s complications?  I don’t see it that way at all.  It is true, however, that preventive care and cognitive medical services (as opposed to invasive procedures) are poorly funded by insurance.  That’s an economic and political problem, not an ethical one in physicians and researchers.
 
Full disclosure:  My defunct outpatient medical practice is mentioned in chapter five.  The author outlines my efforts to provide conscientious care to people with diabetes – mostly type 2 – despite poor funding from insurers (primarily Medicare in my practice at the time).  Poor pay for cognitive services forced me to close my office.  I found Mr. Hirsch to be a thorough and accurate researcher.

[I’m a hospitalist and health blogger now.]

Other highlights of the book are discussions of Dr. Elliott Joslin, an overweight Southern black woman (the Diabetes Queen), intimate details about the type 1 diabetes experience from the patient and family perspective, Dr. Richard Bernstein, insulin pumps, islet cell transplants, origins of the Juvenile Diabetes Research Foundation, Douglas Melton and stem cell research, research rivalries and funding, and inspirational survivor tales.

Mr. Hirsch rightfully criticizes many aspects of the health and medical fields with regards to diabetes.  Thankfully, he never suggests a sweeping government take-over of the healthcare industry.  He urges diabetics – people with diabetes – to take care of their own disease and demand improvements in the current system.

The U.S. already has 24 million people with diabetes and another 54 million with prediabetes.  Approximately one of every three persons born in the U.S. in 2000 will develop diabetes in his or her lifetime, according to the Centers for Disease Control and Prevention.

I agree with Mr. Hirsch that diabetes is “the country’s leading public health crisis,” driven by obesity and the aging of the population.”  This book will help alleviate the damages. 

Steve Parker, M.D.

Disclosure:  I bought this book at Amazon.com.  I was not paid to review it.