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The Streetlight Effect—Is There Light at the End of the Tunnel?

Discussion in 'Research' started by Ellen, Mar 29, 2015.

  1. Ellen

    Ellen Senior Member

    Oct 22, 2005
    Full text here: http://diabetes.diabetesjournals.org/content/64/4/1105.full

    The Streetlight Effect—Is There Light at the End of the Tunnel?
    Åke Lernmark⇑
    + Author Affiliations

    Department of Clinical Sciences, Lund University/Clinical Research Centre, Skåne University Hospital, Malmö, Sweden
    Corresponding author: Åke Lernmark, ake.lernmark@med.lu.se.
    Autoimmune type 1 diabetes research and treatment are seemingly plagued with problems. Large and small, mostly well-thought out clinical studies and trials since the early 1980s have basically been negative. None of the treatments tested have reached clinical routine to replace current lifesaving insulin replacement therapy. A combination type of therapy to diminish the requirement for insulin is yet to be found. The chronic autoimmune disease at the time of clinical onset of type 1 diabetes has been the “winner” in all attempts made so far to stifle the disease process. The disease is also the “winner” over islet transplantation, a potential cure for diabetes. Islet transplantation research was drastically reduced after it was found that the so-called Edmonton protocol did not yield sustainable insulin independence despite short-term restoration of endogenous insulin production and glycemic stability (1). The Diabetes Control and Complications Trial (DCCT) study, well known to all, continues to underscore the importance of glucose control. The reduction in the risk of complications resulting from intensive therapy in patients with type 1 diabetes persisted at least for 4 years after the study was completed, despite increasing hyperglycemia (2). Notwithstanding progress in the overall diabetes management, we were all recently reminded of the fact that type 1 diabetes remains a deadly disease (3). Although mortality was the highest in patients with poorly controlled diabetes, it was reported that patients with type 1 diabetes with A1C of 6.9% or lower had a risk of death from any cause that was twice as high as the risk for matched control subjects (3). Against this background of an uphill battle, the current issue of Diabetes contains a Perspective by Battaglia and Atkinson entitled “The Streetlight Effect in Type 1 Diabetes” (4).

    In their Perspective, the authors put forward several remedies to …

    [Full Text of this Article]

    (ABOVE is an article which is commentary about the following article)

    The Streetlight Effect in Type 1 Diabetes
    Manuela Battaglia1 and Mark A. Atkinson2⇑
    + Author Affiliations

    1Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
    2Departments of Pathology and Pediatrics, University of Florida, Gainesville, FL
    Corresponding author: Mark A. Atkinson, atkinson@ufl.edu.

    In the nearly 100 years since the discovery of therapeutic insulin, significant research efforts have been directed at finding the underlying cause of type 1 diabetes (T1D) and developing a “cure” for the disease. While progress has clearly been made toward each of these goals, neither vision has been fulfilled. With increasing pressure from both public and private funders of diabetes research, growing impatience of those with T1D at the lack of practical discoveries, increased competition for research funds, uncertainties on the reproducibility of published scientific data, and questions regarding the value of animal models, the current research environment has become extraordinarily difficult to traverse from the perspective of investigators. As a result, there is an increasing pressure toward performance of what might be considered “safe” research, where the aim is to affirm existing dogmas rather than to pioneer efforts involving unconventional thought. Psychologists refer to this practice as “observational bias” while cartoonists label the process the “streetlight effect.” In this Perspective, we consider notions in T1D research that should be subject to bold question and provide additional concepts, many somewhat orphan to research efforts, whose investigation could lead to a means for truly identifying the cause of and a cure for T1D.

    Received August 3, 2014.
    Accepted November 7, 2014.
    © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

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