The Cure

1. What the heck is Fascination Street really about?

JB: Well Andy, you probably know this off the top of your head so correct me if I’m wrong.  I read somewhere that this song is about an all-night booze-fest in New Orleans. But I don’t know.  It just feels… seedier than that. Part of me thinks Robert Smith was wandering De Wallen, window shopping for the right girl to take out to a dimly light bar where he could sing her a creepy acoustic version of “Lullaby”.

Andy: Isn’t every version of Lullaby creepy?   Yes, it was based on some “band adventure” (as Robert Smith called it) in New Orleans in the mid-80’s.   I love this song because it’s so dark and fantastic.  Even without knowing what the song is specifically about, it makes me feel like I’m on a journey someplace foreign to me, and it puts me in exactly the mood that they’re conveying. That’s really fantastic and exactly what a great song, film, or piece of art should be able to do.

JB: It was well liked by many, wasn’t it number one for a month or two on the new (at the time) Modern Rock Tracks that Billboard created?   Fun note of trivia – can you guess which song was the first Number One on MRT? It started in 1988…

Andy: Ummm….

JB: I’ll give you a hint…   “Golly jeepers, where’d you get those peepers?”

Andy: Oh, ok, Siouxsie and the Banshees — Peek a Boo. Fun side note: she and Robert Smith dated for a while, and the song “The Walk” was about an actual date they went on. He saw her look like a Japanese Baby and in an instant he remembered. . .  everything. . .

JB: Peek-a-boo is a totally appropriate tie-in to hookers in windows.  Well done, us.

2. If you could cure one disease, what would it be?

JB: This is a tough one for me.  My first inclination is always “cancer” but cancer is such a  complex set of disorders it isn’t likely something we can “cure”.  Searching for a cure has led us to great strides in cancer remission (like in testicular cancer for example) so it is still an admirable goal.  But not one I think we might get to in the near future.

Andy: That’s really tough. Because I would want to look at what’s killing people, what’s debilitating people, how many are affected, and what the outcomes are. For instance, why do we still have cholera or dysentery? Can I choose to give people unlimited clean water and sanitation? Because that’s sort of the root cause… but that is kind of a cheat. It’s not curing one disease, it’s solving a whole host of problems.

JB:  I’m with you on that.  It seems leaning towards diseases that have high mortality and quality of life concerns.  Working in both health promotion and pharmaceutical science, I feel like we could do a much better job of preventing illnesses and focusing cures on things that may not be as easily prevented. You look at malaria for instance, where we could reduce so much global mortality and morbidity focusing on, and providing, a cure, but is not as easy to prevent due to sociocultural influences.   

Andy: Malaria should be a sort of no-brainer. We know how to cure it. We know how to prevent it. It kills and hurts so many. I like the approach The Gates Foundation is taking in trying to just help with that one disease. I also sort of think, should I waste curing one disease on one that Bill and Melinda Gates might get rid of in our lifetime? Maybe I should choose heart disease or diabetes. And that makes me think maybe if “addiction” is a disease? Can we cure that?

JB: It’s a good question – what is your viewpoint on addiction and other mental illnesses as a curable disease?  I thought about this but wasn’t sure where it might fall.

Andy: I’m of two minds on this (surprising). As someone who struggles with mental health (ADD, depression) myself, I want to be very clear that I think mental health is just like any other aspect of health and should be treated the same way. A large part of “curing” mental illness is likely in destigmatizing it so people can get basic preventative and palliative care the same way you would for the flu or conjunctivitis. If everyone in America got 10 hours of free therapy a year, it would go a long way. I think the second question is, do you “Cure” mental health issues? You can take a lot of different drugs and they will help, but some things maybe don’t go away for some people. It’s probably more like managing a chronic illness– and just like some forms of chronic illness, the answers are environmental factors, or diet and exercise, etc. While I know depression is very, very, very real, I also know that many of us have triggers that put us into depressive phases, and maybe we can learn to recognize them and get help when we see us going towards them. Not everyone can, but in the same way my wife tells me I should go to the doctor to get my blood pressure checked, we can have support systems that help us find the care we need. I don’t know, though. There are no easy answers.   

JB: I’ve never heard anyone say there’s a “cure” for mental illness (at least as a general category) but rather multiple techniques that can moderate or mitigate their influence.  So I would imagine you are correct in your analogy to something more chronic. Especially with the genetic tie-in to many of them. With the difficulty in this question for us, I’m tempted to make my final answer the common cold.  Yes, I know it somewhat goes against my “prevention versus cure” angle, and I also recognize there are 200 cold viruses, but just think – if none of us got the cold we would have all that additional time to work on cures. Plus the billions we would save in cold remedies which we could use for destigmatizing and creating better prevention for the other ones we have mentioned.  

Andy: Then could I choose allergies? Because the same reasons. Can we put more resources into other things than having to take a bunch of pills, or shots or whatever? That’s still sort of a cop-out, though, so I will stay true to the spirit of the question and choose. . . the flu? For some of the main reasons you just said, but also it’s a real killer and has the potential to still wipe out a huge portion of the planet. A century ago, the Spanish flu infected a third of the planet and and killed tens of millions of people. We can try to vaccinate and prevent it, but eventually there may be a strain that infects a lot of us. I think that’s worth wiping out, along with the millions of people who die every year from the flu anyway.

JB: I think you and I will talk about this more in the next question, but I think we both agree that alleviating precursors or environmental factors that cause widespread disease would be what we’d most like to take care of.  Clean water, clean air, better germ prevention – those kinds of things, if we could ‘cure’, would certainly take a huge burden off of not only our morbidity and mortality rates but our healthcare financial system as well.

3. Should we spend more money on “curing things” or “preventing things”?

Andy: Yes. Yes we should. I don’t think this is an “or” question. It has to be an and, but I get that that is a cop out answer. So where should the balance go? Probably prevention.

JB: The question to me is always where is the best use of resources.  By nature it seems more expensive to “cure” something – whether it is research and development costs or dissemination etc.  Based on what we discussed above, prevention could be framed as more cost-saving than cost-increasing – unless you count that we do a relatively poor job of it and could use a substantial increase in funds to make it more appealing…

Andy: Our healthcare system is so incredibly steered towards treatment and procedure and not at all towards looking at the larger picture. Very few of these major diseases exist as a lone vector, but are caused by large systems that mostly exist outside the walls of hospitals and doctors offices– in grocery stores, schools, kitchens, restaurants around the world. It’s why basic stuff around clean water is so key. It solves a myriad of problems. So does education. But then again, so does research. Figuring out our genomes early and telling a 16 year old Andy specific things to look out for and stop doing would probably mean a much more fit 40 year old Andy. And when it comes to issues like mental health, trying to determine the balance between environmental and genetic factors and developing better prevention mechanisms for both… along with how we can mitigate the physical comorbidities that go along with it.  

JB: One of my biggest frustrations with most healthcare industries is our inability to do just that.  We are afraid of insurance companies knowing our history (and charging us more) so we don’t want increased genetic research.  Healthcare companies are afraid of the public perception of the outcomes they have, so they don’t do the research that could improve treatments or systems.  And we certainly don’t seem to understand the linkages between what people “should” do and what people would “prefer” to do. There’s a myraid of discussions there, between the consumer’s role (or apathy) versus the marketers ethical responsibility towards appropriate healthcare behaviors, and so on.

Andy: I wish eating salad was marketed as well as Cialis. Old people sitting in bathtubs eating nothing but leafy greens. Warning: side effects may include being boring, telling people all the time about the wonders of kale, and excessive flossing.

JB: But those commercials require you to be in a separate bathtub, thus negating the value of the drug you just took…

Andy: If your salad consumption takes longer than 4 hours, contact your doctor.  

JB: Or your dentist.  Sheesh.

Andy: It’s also worth noting that “diet and exercise” are somewhat classist ideals. So many people live in food deserts where they can’t buy fresh food, and purchase high calorie, high sodium, high fat, high sugar food because those foods are cheap. Folks might love to buy some quinoa and kale, but Wonder Bread or 10 ramen noodles only costs a buck. A huge part of the prevention angle is ending these sorts of problems so people have access to and can afford the things that won’t kill them. Which goes back to my earlier point about clean water. You fix the underlying issues and you fix a whole host of things.

JB: For semantic purposes, let’s consider any systemic change that benefits the populace’s health to be prevention (cleaner water, cleaner air, etc) rather than a cure.  With that definition, who knows what things we could cure by having the appropriate environmental safeguards in place (not even getting into the genetic piece). Perhaps spending a wider range of funds on the prevention part creates cures in and of themselves.  Like you said, how many global issues can clean water take care of?

Andy: Enough that it should be a basic policy goal of most global politicians. Same goes for clean air. We don’t “cure” asthma, but if we eliminate enough smokestacks and tailpipes, we sure prevent enough people from ever getting it, ever needing an inhaler or a breathing treatment.  Or if we provide relatively healthy cost-effective food in corner markets and low income neighborhoods we could prevent more people from getting heart disease or diabetes.

JB: That ounce of prevention is a literal pound of cure.  All things considered, I don’t think there’s a bad place to spend money, between cure and prevention, but it does seem like we could do some additional systemic good with a little more focus on the preventive aspect.  

Andy: Absolutely.  And with that pound of Cure, I recommend the song “More Than This” which was on the X-Files movie soundtrack.

JB: And I would hope you would also listen to their cover of “World in My Eyes” on the Depeche Mode tribute album (possibly the best tribute album in the history of tribute album).  

Andy: That’s all there is. Nothing more than you can cure now, that’s all there is…

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