Bittersweet: Diabetes, Insulin, and the Transformation of Illness by Chris Feudtner, MD. Chapel Hill, NC: The University of North Carolina Press; 2003. 290 pages, hardcover, $29.95.

Bittersweet, by academic pediatrician Chris Feudtner, is a beautifully-written book, by a highly gifted writer. In an enthralling way, Feudtner penetrates to the historic roots of diabetes and describes the transformation of diabetes from an acutely lethal disease to a chronic condition, with the advent of insulin therapy in 1922, and the resultant bittersweet ramifications of this historic transformation. Feudtner grafts a distinctly humanistic flavor into an overall historic framework of diabetes and is hopeful of helping persons affected by diabetes and other chronic conditions to better understand how therapeutic advancements in medicine may have actually paradoxical effects. Feudtner has, indeed, crafted a stellar book that greatly contributes to furthering an understanding of the humanity of health and illness and that is a solid counterbalance to unrestrained enthusiasm for therapeutic and technologic "advancements" in medicine. In a realistic sense, the book may be of practical value to all persons, in their personal struggles with ill health.

The central thesis of Feudtner is that there has been a bittersweet transformation of diabetes, wrought by the wondrous drug insulin. In a metaphoric sense, the transformation has been "sweet" because diabetic patients will generally live longer since the therapeutic advancement of insulin. But paradoxically, the transformation has been "bitter" because diabetic patients will generally live longer, albeit in a chronically diseased condition and vulnerable to long-term, diabetes-related complications such as kidney failure, nerve damage, retinal disease, and atherosclerosis. This bittersweet paradox is carefully revealed by Feudtner, in substantial part, by artfully dissecting and examining multitudinous patient records and letters compiled by diabetes pioneer Dr. Eilliott Joslin; fragments of these fascinating documents, in fact, are the bedrock principally supporting the textual contents. A goodly number of interesting illustrations, as well as instructive tables and figures, further underpin the text.

This wonderful book is written in lay-reader-friendly fashion, and it has an uplifting spirit throughout the pages of the book. Drawing largely on the sobering life stories of diabetic patients, Feudtner recounts the bittersweet historic transformation of diabetes. Wielding a humanistically inclined pen, Feudtner succeeds in putting a human face on the insulin-transformed disease of diabetes, as he describes the issues for diabetics relating to responsibility, control, and disease management. Importantly, the humanistic strand prominently binding together the textual contents may potentially help smooth the future path of medicine by sharply focusing attention on the salient need to consider carefully the far-reaching consequences of transforming some disease into a chronic condition, as the result of therapeutic advances.

Although Feudtner, with considerable intellectual vigor, plainly states a philosophical viewpoint closely embracing humanism, it should be understood that others in the medical world may have differing perceptions and variant views. Also, the core anatomy of the book is fleshed out by the particular experiences of a relatively small cohort of patients; the information garnered from these patients is of an anecdotal nature, and their individualized experiences may not fully reflect the experiences of diabetic patients drawn from a wider panorama of sociocultural, socioeconomic, ethnic, and geographic backgrounds.

With these warnings, this moving book should be of immense interest to health care and public health professionals, perhaps particularly those concerned in a research or clinical sense regarding diabetes and other chronic illnesses, and to chronically ill persons and their families.