With all of my STARFLEET chapter's preparations for the new STAR TREK movie opening next Friday, I decided to take a few minutes' retrospective to consider how diabetes might be treated in the STAR TREK universe, and how I expect it might be treated in Real Life.

In both the original STAR TREK series (sometimes called "Classic TREK" or "TOS") and STAR TREK: Voyager, the doctor characters talk of the routine nature of tonsillectomies and appendectomies, indicating that most of today's typical medical issues still exist. While one 1960's episode ("This Side of Paradise") introduces a spore that almost-magically repairs all injuries and regrows surgically-removed organs, those spores are completely destroyed by the episode's end. And in STAR TREK IV: The Voyage Home, Doctor McCoy gives a dialysis patient a single pill, by which she all but instantaneously grows a new, functioning kidney.

If a new kidney, why not a new pancreas -- or new beta cells?

But then there's the other issue: patients who cannot tolerate the 23rd and 24th century drugs. In STAR TREK II: The Wrath of Khan, McCoy presents Kirk with a pair of spectacles to counteract presbyopia with the words, "For most patients of your age, I'd prescribe Retinax." To which Kirk replies, "I'm allergic to Retinax." So too, there may be allergic reactions -- as well as autoimmune reactions -- to a "new pancreas" pill.

So, does diabetes still exist in the 23rd- and 24th-century STAR TREK universe? In STAR TREK, human-dominated planets have a strong cultural, historical, and legal bias against "genetic enhancement". Most of those humans would not use gene therapy to selectively remove genetic tendencies towards diabetes. Still, that doesn't mean that would-be parents with those genes might not be counseled against having biological children, or counseled to terminate a pregnancy where the child would be born with "genetic defects". The Roddenberrian Utopia suggests that the 23rd-Century post-religious Earth has resolved global social issues of poverty, overpopulation, intraplanetary war, and unequal access to medical care. In such an environment, the choice to become pregnant, and the choice to continue a pregnancy to term, could be made with as much passion as that of a farmer choosing which of his seedlings to allow to grow, and which to cull.

On the other hand, there is no context I am aware of in which abortion is discussed as an option. Indeed, we learn in STAR TREK: Insurrection and STAR TREK: Nemesis that Captain Picard has a rare genetic disorder (the fictional "Shalaft's Syndrome") which runs throughout his family. This suggests that the social and medical issues of genetic and chromosomal abnormalities may not be as devastating as they are today -- and that common genetic conditions of the 21st century (such as autoimmune diabetes) may be resolved through non-genetic medical therapy.

Which begs the questions:  if diabetes still exists in the STAR TREK universe, how might it be handled? And how does that differ from what we today think diabetes might be handled 250-300 years from now?