Jan and John are finishing up their rounds, and heading to the hospital cafeteria for lunch. John re-opens yesterday’s conversation about the word ‘cure’.
“Well, did you learn anything about the medical definition of cure in your research last night?”
Jan is frustrated, “I learned that medical dictionaries don’t take the word ‘cure’ seriously.”
“Really? For example?”, John picks up a tray and orders a Reuben sandwich.
“First I went to Stedman’s Medical Dictionary. It gives several definitions. The first one is ‘to heal, to make well‘. But healing is, as we’ve already discussed, independent of curing the illness – healing happens before, during, and after the illness. And ‘to make well’ is just simplistic. We could go on another dictionary search to find the meaning of ‘well’ – I think it’s less well defined than ‘cure’.”
“I see that. To make well, might range from an apology, meant to make the patient feel better, to a painkiller that makes them feel better, to a cure.” John challenges. “But doesn’t ‘well’ in medicine mean without disease?”
Jan responds, “It’s OK in simple cases, but many cases are not simple. What if someone has more than one illness.”
“Yes, an elderly person might suffer from obesity, hypertension, arthritis and diabetes.”
“Then, the Stedman’s definition says you can’t just cure one illness, because they are still sick? ”
“Now you’re getting technical and pedantic,” John comments dryly.
“If we are to define cure, we need a definition that holds up to such simple challenges,” Jan went on, “the second definition is ‘a restoration of health‘. Does health disappear when someone gets sick? I don’t think so.”
“Health is always present, as long as we are alive. Maybe they mean that ‘some health is lost’ when we get sick, and we recover it when we get better.” John offered.
“But restoration of health happens before, during and after the disease is diagnosed. often happens after the disease is stopped. They’re still mixing and confusing healing and curing.” Jan objected.
She continued, “Their third definition is ‘a special method or course of treatment‘. That seems OK at first, but many, perhaps most treatments simply do not cure – most treatments are for symptoms, not cures. In fact, a ‘course of treatment’, might be given to someone who is not even sick, not in need of a cure. I can get a hair treatment – so I look better. But there is no intent to cure my ugliness.”
“You’re not ugly,” John laughed, “but it’s an interesting comparison. So, Stedman’s Medical Dictionary defines cures that are used when you are not sick, when you are sick, and even after your sickness is gone. Is that so bad?”
“It’s worse, they don’t even use the word disease, or illness. Can you cure someone if they don’t have an illness?” Jan showed John the text:
Jan continued, her voice getting louder, “How can we cure people, how can we search for cures, if cure is not properly defined? Can there be a science of medicine, if we can’t even find a good definition for ‘cure’?”.
John responded quietly, “Did you check anywhere else?”
“Yes. Mosbey’s Medical Dictionary is different, but no better. They first defined cure as ‘restoration to health of a person afflicted with a disease or disorder‘”.
“At least it mentions disease,” John comments.
“Yes, but it’s the same ‘restoration to health‘, implying that once you have a disease or a disorder, you are no longer ‘healthy’. But health doesn’t disappear because you have an illness. It is there, actively fighting the disease. If you lose your health – you are dead.”
“Well, many diseases are the result of a drop in health, and a restoration of health is the only real cure. Scurvy is caused by an unhealthy diet, and cured by a healthy diet.”
“Yes,” Jan agreed. “It almost seems they have recognized that restoring health can cure a disease – but I don’t think it was meant that way. If so, they might have said something like ‘an improvement in health that eliminates disease‘.”
Jan continued, “It doesn’t actually speak about stopping the disease. What if health is restored, but the disease is still present. Is that a cure?”
“Is it possible to ‘restore health‘ without curing the disease?”
“Of course. The unhealthiness might be disconnected from the disease – once the disease takes hold. If you get cholera from drinking unhealthy water, and you stop drinking unhealthy water – it doesn’t cure you.”
“And what is a ‘disorder‘?” Jan continued, “A broken leg is a disorder – but we don’t cure it. The definition is simply useless as a scientific tool.”
“Yes, I see that. We don’t cure disorders, only diseases. Do they give another definition?”, asks John.
“‘The favorable outcome of a treatment of a disease or disorder‘. It’s simplistic nonsense. A person has arthritis, and they take some medicine that makes them feels better, it’s a favorable outcome. So the medicine ‘cured’ them, according to Mosbey’s. But they still have the disease, and it’s probably getting worse.” Jan is visibly frustrated. She stops talking and looks at John, hoping for an answer.
“Hmm..”, John thinking aloud, “Interesting that Stedmans does not require a disease to find a cure, and Mosbey’s does not require stopping the disease to produce a cure. It’s like the old joke, ‘the operation was a success, but the patient died anyway.'”, John smiled.
“It’s more than that. A favorable outcome as defined by the doctor? or by the patient? A patient who is so sick they want the right to die, would consider a treatment leading to death as a favorable outcome. Does that make death a cure?” Jan asked, rhetorically adding “A favorable outcome is not always a cure, although a cure is almost always a favorable outcome.”
“Almost always? Wouldn’t it be always?”, John asked.
“Well, there are cases where medicine attempts to ‘cure’ a disease that others don’t consider a disease. There have been searches for medical cures for left-handedness, and homosexuality. In those cases, a cure might not be a favorable outcome for the patient nor for the society.”
“A cure that cures a non-disease. Interesting. You’ve been thinking about this a lot. It seems Mosbey’s has got stuck on a challenging question: does a cure cure the disease, or the patient?”, John looks up at the clock. “Well, time to get back to work. Maybe if you check some of the authoritative medical reference books, you can find a better definition of cure?” He gets up and starts to clear the table.
“So.. both the medical dictionaries actually say that ‘cure’ is to stop a disease?”
“Not only that, one doesn’t use the word ‘disease’, and the neither requires actually ‘stopping’ the disease. I wonder what MERCK says”, Jan replies. “I’ll check tonight. Tomorrow’s lunch, then.”
“Tomorrow is my weekend.” John replies with a smile, “You’ve got Tuesday and Wednesday to do your research. See you Thursday.”
Standard dictionaries don’t provide a clear definition of cure. And medical dictionaries don’t do any better. Will Jan and John find the true meaning of cure? Stay tuned…
to your health, tracy
This post is the second in a series about the word ‘cure’. You can see the first post here: “What means Cure?“