In my previous post, I took a few examples of STAR TREK's medical technology and cultural biases to
speculate on whether or not diabetes mellitus might exist among humans living in that fictional universe, and
some methods by which it might be treated.

In the series and movies we've seen that cases of organ failure can be treated by drugs (STAR TREK IV: The Voyage
Home's "kidney pill"), organ cloning (Picard's heart in STAR TREK: The Next Generation), and other
regrowth methods ("automatic bone knitters") -- all of which avoid (culturally-taboo) gene therapy and genetic
engineering. We've also seen that rare diseases, not yet known today, are routinely treatable. So in STAR TREK, my Type 2 diabetes might as easily be treated with a single pill as with a continuing
course of oral medications, and your Type 1 diabetes might be treated with some sort of retrovaccine as soon as
it began to manifest.

But what about "in real life"?

Thus far, 21st Century medical science has led us to discover something like fifteen distinct genes that cause (or contribute to)
autoimmune diabetes, six or more distinct genes that individually cause different types of MODY (monogenetic diabetes),
and (if I recall correctly) nine or more distinct genes that contribute to insulin-resistant diabetes and metabolic
syndrome. While it's easily argued that diabetes requires a lot less intensive management than (and is a lot less disabling and/or fatal than) conditions such as spina bifida, cystic fibrosis, or Tay-Sach's
disease, a determined Darwinist might suggest that until gene-splicing technology allows us to replace these
"defective" genes with "non-defective" ones, people with any potential for genetically-based diseases (including diabetes) should not have biological children -- or at the least, should not let a "potentially diabetic" fetus develop to term.

Such measures would be Draconian in the extreme -- not to mention running afoul of many religious and ethical taboos.

I would consider it more likely that we will be presented with a series of increasingly less-inelegant "artificial" and
"regrown" pancreases (or perhaps, as reader skjohn8 suggested, something closer to "smart insulin") which would be interrim "but this is a cure!" treatments while scientists, doctors, and
clergymen debate the bioethical issues that will delay the development of gene therapy and self-tissue cloning and grafting
as acceptable methods of treating autoimmune diabetes. Despite the controversy, I would expect that gene therapy and
custom embryos would eventually become the norm for even those of moderate income -- potentially eradicating today's autoimmune
diseases by the end of the 22nd Century.

While STAR TREK's spores that restored people to perfect health may have been destroyed, there are many
directions for the advancement of pharmaceutical research. If we can dream of a future pill that can grow a kidney,
then perhaps our next generations of pharmacists and geneticists can create a pill to deactivate the "diabetes-specific"
or "autoimmune-overreaction-specific" function of those of diabetes-related genes. Or perhaps medical care might be
more as we saw in STAR TREK: The Next Generation, where Captain Picard receives a new heart that has
been grown from his own tissues and genetic code. This sort of transplant -- also hinted at in a future-looking series on
the Science Channel -- would not trigger an immune response in most people -- so it would certainly be a "cure" for
Type 2 diabetes -- but without a greater understanding of the causes of autoimmune cascades, this might not be the
Holy Grail for Type 1.

One of the greatest strengths of future-speculative fiction is that it awakens in us the thoughts of paths of scientific investigation
from which our future medical therapies may derive. Whether it be gene therapy, stem cells, autoimmune blockers, or other
as-yet-unperceived and -unconceived methods, scientific, medical, and pharmaceutical researchers strive for -- and may
some day develop and discover -- that elusive therapy that will give many of us what we most wish for: a "normal" life. Until then,
keep watching, keep dreaming, and keep the hailing frequencies open.