Religion & Liberty Online

Dickens, Diabetes, and Positive-Sum Games

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Bad news is always unwelcome and can be terrifying, especially when it affects the health and well-being of someone you love. But we live in a world of innovation and modern miracles such that even bad news often comes with hope in its trail.

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Is it this best or worst of times? Pessimism sells, but the reality of our daily lives makes a case for optimism today and hope for the future.

The preponderance of negativity and pessimism in the news makes it easy to believe that the world is at its worst, but my experience and yours can reveal that it may be the best of times. I am reminded of perhaps the best all-time opening lines of a novel, in Charles Dickens’ “A Tale of Two Cities,” penned in 1859. The story is set in London and Paris during the onset of the French Revolution. It reads:

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way—in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only.

Londoners and Parisians saw that everything was changing and could understand their experiences only in hyperbolic terms. They simultaneously had it all and nothing. It was the best of times, but the worst was coming. Dickens published the book six decades after the onset of the French Revolution, which, of course, was a dastardly experiment with mercantilism resulting in “deficit spending; regulation of private enterprise; nationalization of property; wage and price controls; and inflationary destruction of the monetary system.” The French were forced to learn a painful lesson, the consequences of which persisted until 1794, when anti-Jacobin factions in government gained traction and made the case for freer markets.

Dickens’ words still echo in our modern world. We live in a time of unprecedented abundance despite the naysayers and contrarians. Consider this: Dickens, one of the wealthiest self-made men in England, could not have fathomed a world where his books were readily available to anyone and where candlelight was no longer required for evening reading. He would be astonished to learn that you can “read” a book by listening to it while driving your own car. The average person in an industrialized economy today lives a longer, healthier, and wealthier life than anyone in Dickens’ time.

In 1850, the global average life expectancy was just over 29 years, with Europe leading the way at 36 years. By 2020, the global average life expectancy was around 70 years, and all countries have benefited. Moreover, global literacy rates have exploded. In 1820, only 1 in 10 people could read and write. Today, only 1 in 10 people are unable to read and write. In Dickens’ time, even if you could afford a book, you likely couldn’t read it. Today A Tale of Two Cities costs less than a dollar if you have a Kindle, and under $4 for a paperback, representing less than an hour of work at the U.S. federal minimum wage.

The institutions of economic and human freedom, so elusive to humanity just 200 short years ago, extend our lives and livelihoods. The forces behind all this are human capital and human creativity, the talents God endowed you with for the things he wants you to do. Thus the rules that govern our daily choices should direct our creative energies in the service of others. Only then can we escape the zero-sum games that have dominated human history and experience positive-sum games wherein I only profit when I serve you well. Private property rights, which respect human dignity and agency, are therefore required. Economist Armen Alchain refers to property rights as “human rights”—they give us agency over our time and labor.

This does not create a paradisiacal world, nor is material well-being all that matters, but it fosters greater human flourishing, one where we can serve and be served by our fellow human beings. Death was not part of God’s design or desire for his creation; it was the curse of sin. Yet, despite our sins, God calls us to work and create with excellence and thereby glorify him, the Master Creator. It’s what we were ourselves created to do. When we obey the command to be fruitful and multiply (Genesis 1:28; 9:1), we create more material abundance, which is not just about having more children—or more stuff. It’s about community, fellowship, service, friendship, and family, all of which depend on our living longer and healthier lives to glorify God.

This brings me to my story. Death is horrific, no matter how it comes, and we desperately avoid it. We fear sickness and disease. As our material abundance grows, our natural expectations are for longer and healthier lives. Thankfully, child and maternal mortality are declining, remarkably so in a wealthy country like the United States. It has become easy to take our health and well-being for granted.

Guilty as charged. Last spring, my 13-year-old son, Parker, complained of not feeling well. He felt dizzy and nauseous at school, particularly between breakfast and lunch. As a growing teen, we figured he needed more food and couldn’t go for six hours between meals. I sent him on his way daily with a granola bar in his blazer. This didn’t solve the problem, and no obvious symptoms indicated an illness. He wasn’t vomiting, had no fever, and wasn’t coughing or congested. It was easy to think it was nothing. Over several weeks, he occasionally called us to pick him up from school with the same vague symptoms. One night, he was starting to feel constantly thirsty. Soon after that, he called again to come home from school early, and we made a doctor’s appointment that day, still thinking it would be nothing serious. I will never forget that week and what followed.

We saw the pediatrician late Tuesday afternoon. She took his blood pressure at various intervals of sitting and standing and tested his A1C (blood sugar) levels. A normal level should be below 5.7%; his was a little over 8%, but he had just eaten, so maybe it was nothing. I could tell, though, that she was worried. She explained that when your pancreas functions normally, even after eating something high in sugar, your body works to produce insulin, and your blood sugar maintains a tight range. Even though he had recently eaten lunch, they shouldn’t be high. I knew nothing about A1C tests, but that day I learned that two independent A1C tests over 6.5% indicate diabetes. His was 8.4%. Moreover, the A1C test measures your average blood sugar over the past three months, which is more reason to worry that his test result wasn’t just about his having just eaten lunch.

After giving another blood sample to be sent out for testing, we left the pediatrician’s office. She would call us and let us know. As we left the office, my voice cracked as I asked, “If this is diabetes, what do we do?” Fear and panic set in. I had to travel for work the next day, and life resumed for everyone. I had two stops on this trip, one to Milwaukee and then Chicago, where my friend Rachel Ferguson had invited me to speak to her students. As I drove to the airport with my co-worker, I received a call from the pediatrician. Parker’s blood work indicated type 1 diabetes. I was stunned. The doctor set up an appointment with a specialist for Friday. I had another talk to give and wasn’t scheduled to return until Friday afternoon. I called Rachel in tears. To add to the chaos, a snowstorm was expected in Chicago. We agreed to postpone the event, and I got on my next flight home.

Mercifully, I was able to take Parker to the endocrinologist. Still, in a state of befuddlement, I assumed we would go to the appointment and then I would drive him to school; he went in his uniform! Nope. She calmly explained how our lives were forever changed and thought it was sure that he had type 1 diabetes. So much so that we were to leave and go to the hospital, where they would monitor him—and he would not be discharged until we knew how to take his blood sugar and inject insulin.

Parker’s condition is inescapable unless there is a cure. He can never have a spontaneous cookie. He must calculate everything he eats. We sent him to his first overnight summer camp last year, and I prayed that he would not die in his sleep if his sugar plummeted. We have transitioned from insulin pens, which you inject, to an insulin pump, communicating with his continuous glucose monitor. He has two devices always attached to his body. They communicate with his phone and ours. Remarkable and miraculous. No matter where I am, I can check the app on my phone and read his sugar levels. This is both a blessing and a curse, but mostly a blessing. Type 1 diabetes is a terrible disease, and I hate that he has it. I wish I could switch places with him. I can’t. These things make it feel like the worst of times, and tears fall onto my keyboard as I write this, even a year after diagnosis. Some worries I have as his mom feel insurmountable. What if the pump breaks? What if he doses insulin incorrectly? What if he slips into a diabetic coma when he’s riding his bike? The “what-ifs” are terrifying.

Yet, if my child must have this disease, I sure am glad it’s now. It was not until 1889 that two doctors, Frederick Banting and Charles Best, discovered that the pancreas produced insulin, something they learned by removing the pancreas from dogs, who then developed symptoms of diabetes and died. J.B. Collip and John Macleod developed a more refined insulin from cattle pancreas. They won and shared the Nobel Prize in Medicine with Banting and Best. In 1922, Leonard Thompson, a 13-year-old boy, Parker’s age 100 years removed, was injected with insulin, and within 24 hours his blood sugar levels returned to normal. Synthetic insulin was not developed until 1978, and it was commercially sold by Eli Lilly in 1982.

Before 1921, diabetes was a death sentence, and children who had it were put on high-fat, high-protein diets, which usually extended their lives for a few weeks or months. Pediatric diabetic wards were death chambers, with children merely clinging to existence in a state of diabetic ketoacidosis, waiting to die. Chris Feudtner, pediatrician, clinical investigator, and ethicist at The Children’s Hospital of Philadelphia (CHOP), calls the invention of insulin “one of the leading miracles of the 20th century, on par with antimicrobials and cancer treatments.” A miracle indeed. Brought to us by the human mind empowered to think, problem-solve, and innovate.

Leonard Thompson lived 13 more years after receiving the first dose of insulin and then died from pneumonia. I hope Parker can make it much longer; statistically, he has a good chance. The average life expectancy for a type 1 diabetic is almost 71 years. We are not promised long lives, and every day is a gift. There are still 24 low- and middle-income countries (LMIC) without registered insulin, such as Somalia and South Sudan. There, diabetes remains a death sentence, and they live as Leonard Thompson expected to until his miracle arrived.

Would I take this position that it’s the best of times if Parker had been diagnosed with a lethal cancer? I hope so. I know it could be far worse, and it is for many of our fellow human beings worldwide. Each person has dignity, is unrepeatable, and bears the image of God. Often, they lack the life-saving resources that allow me to take my health for granted, something I hope I’ll no longer do. Nor should we take for granted the availability and affordability of insulin. The insulin-cost controversy has received much attention, resulting in the three major U.S. insulin retailers capping the price of insulin at $35 per month. That’s good news if you’re insulin-dependent, but what will sustainably increase access to insulin is reducing the convoluted and cumbersome regulatory process that makes U.S.-manufactured insulin prices 4.5 higher than in Mexico and 38 times higher than in Turkey. Letting the market work through rigorous competition creates incentives for firms to compete on price and quality, and is the best protection against shortages—a dire concern for diabetics.

It’s easy to be dragged down by the bad news that inundates us daily. It’s the best of times not because we’ve obtained utopia but because we have come so far due to free markets and the virtues upon which they rest. We need more of this, please, and it’s what will ultimately kill cancer, Alzheimer’s, Parkinson’s, and other chronic diseases. The salubrious economic and scientific growth of the past 200 years affords my child the best chance for a full life where he can thrive.

Nevertheless, bad news sells papers and fuels political power. It is the best of times, and they can get even better if we choose the path of economic freedom and employ our gifts in the service of our neighbors.

Anne Bradley

Anne Bradley, Ph.D., is an Acton affiliate scholar, the vice president of Academic Affairs at The Fund for American Studies, and professor of economics at The Institute of World Politics.