We posted a question on LinkedIn asking others how they would define or explain cures and treatments because many Patient’s Manifesto signors thought of them as mutually exclusive terms where cures end a disease and treatments only treat the symptoms.  However, we thought there needed to be a more nuanced discussion of these definitions especially in light of our initiative, “Where Are The Cures?”

Many responses came back explaining the differences and similarities, but the best response by far was from Mark Davison in the UK. He wrote up a longer blog article on the subject below:

Treatments and Cures: Must-Have versus Nice-To-Have?

“Where are the cures?” is an understandable reaction to the slow progress of biomedical research.  Why do things take so long? The scientific method is inherently cautious: to get meaningful results, we design controlled experiments to isolate and test one variable at a time.  The human body, however, has millions of interacting processes occurring all over the body and changing over time.  Translating results from test tubes to people is therefore a tough task.  That research breakthrough we hear about on the evening news may not become a marketed drug for years, if ever.  If there were big shortcuts we’d have found them by now, but maybe a change of emphasis could help.

The success of modern medicine means that most of us see disease and health as opposite states; black and white.  We expect doctors to convert one to the other when required – to diagnose, to treat and to eradicate our illnesses. However, the disease-health relationship is often more like a continuous spectrum than our all-or-nothing perception.  If we view medicine in this way there is value to be had all along the rainbow, even if we never find the pot of gold that is a cure.

In the nineteenth century life expectancy was half what it is today. In the pre-pharmaceutical era survival was often due more to luck than to medicine.  In the Civil War, non-sterile amputations to treat gangrene frequently caused death by septicemia.  Joseph Lister’s innovation of antiseptic surgery occurred in 1867, just after the war ended, and was followed sixty years later by Alexander Fleming’s discovery of penicillin.  By the time of the Second World War, the chances of surviving battlefield wounds (and other previously life-threatening conditions) were much higher.

In the twentieth century, scientific progress made medicine ever more effective. The underlying causes of many dangerous diseases were uncovered.  Today, ailments that would have killed our great-great-grandparents can often be cured or prevented.  In the 21^st century, all the “simple” diseases have now been addressed, if not necessarily eradicated, but more complex problems such as multiple sclerosis still remain to be conquered, despite many billions of dollars spent in pharmaceutical research.

As noted above, we know that drug treatment and cure aren’t necessarily linked in a straight line. Some medical conditions (depression, for example) are difficult to study because of well-known placebo effects. The drug administered may be biochemically no more effective than breath mints, but the medical attention makes the patient feel better and gives the appearance that drug treatment was successful.

Similarly, some patients with chronic illness are never fully cured but effective treatment can liberate them from the tyranny of their condition.  “Absence of pain” or “increased mobility” is usually more important to the chronically-ill person than “freedom from disease”. Maybe we should look for more “functional cures” – treatments that don’t eliminate underlying problems but allow us to live with them and thrive.  This isn’t a new concept – many neurological and auto-immune diseases are already managed in this way, but cure or regression of disease is stillthe primary commercial aim.

In my view, maximum quality of life should be the first goal. Treatments need to reduce symptoms and minimise further damage – still very difficult to achieve, but maybe just fractionally easier to find than a full cure.

Cures will always remain the ideal, and we should continue to pursue them, but they are a home run play and usually the R&D bat swings and misses.  Maybe a drug-based remedy will never be found for some complex, multi-factorial diseases.  Perhaps instead of swinging for the fences we need to bunt and run like hell to first base.

We live in symbiosis with a load of aberrant biology already – we carry more bacterial cells with us than human ones. Maybe some diseases will also be seen as harmless passengers when we find the right medical approaches. Treatment and cure are nineteenth century concepts, when medicine was all or nothing. In 21st century healthcare, continuing research and new treatments can help patients even without curing them.  As Voltaire said, perfect should not be the enemy of good.

About the Author: Mark Davison has held a number of research and commercial roles in pharma and biotech during a twenty year career, including responsibility for CNS therapeutics at a biotech start up.  He is a drug industry consultant and writer.

See Mark’s blog at: http://pharmapieces.blogspot.com

If you would like to contribute an article please contact us at info@wherearethecures.org with your pitch.

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