A cure is a substance or procedure that ends a medical condition, such as a medication, a surgical operation, a change in lifestyle or even a philosophical mindset that helps end a person's sufferings; or the state of being healed, or cured. The medical condition could be a disease, mental illness, genetic disorder, or simply a condition a person considers socially undesirable, such as baldness or lack of breast tissue.
An incurable disease may or may not be a terminal illness; conversely, a curable illness can still result in the patient's death.
The proportion of people with a disease that are cured by a given treatment, called the cure fraction or cure rate, is determined by comparing disease-free survival of treated people against a matched control group that never had the disease.[1]
Another way of determining the cure fraction and/or "cure time" is by measuring when the hazard rate in a diseased group of individuals returns to the hazard rate measured in the general population.[2][3]
Inherent in the idea of a cure is the permanent end to the specific instance of the disease.[4][5] When a person has the common cold, and then recovers from it, the person is said to be cured, even though the person might someday catch another cold. Conversely, a person that has successfully managed a disease, such as diabetes mellitus, so that it produces no undesirable symptoms for the moment, but without actually permanently ending it, is not cured.
Related concepts, whose meaning can differ, include response, remission and recovery.
In complex diseases, such as cancer, researchers rely on statistical comparisons of disease-free survival (DFS) of patients against matched, healthy control groups. This logically rigorous approach essentially equates indefinite remission with cure.[6] The comparison is usually made through the Kaplan-Meier estimator approach.[7]
The simplest cure rate model was published by Joseph Berkson and Robert P. Gage in 1952.[7] In this model, the survival at any given time is equal to those that are cured plus those that are not cured, but who have not yet died or, in the case of diseases that feature asymptomatic remissions, have not yet re-developed signs and symptoms of the disease. When all of the non-cured people have died or re-developed the disease, only the permanently cured members of the population will remain, and the DFS curve will be perfectly flat. The earliest point in time that the curve goes flat is the point at which all remaining disease-free survivors are declared to be permanently cured. If the curve never goes flat, then the disease is formally considered incurable (with the existing treatments).
The Berkson and Gage equation is
where is the proportion of people surviving at any given point in time, is the proportion that are permanently cured, and is an exponential curve that represents the survival of the non-cured people.
Cure rate curves can be determined through an analysis of the data.[7] The analysis allows the statistician to determine the proportion of people that are permanently cured by a given treatment, and also how long after treatment it is necessary to wait before declaring an asymptomatic individual to be cured.[3]
Several cure rate models exist, such as the expectation-maximization algorithm and Markov chain Monte Carlo model.[7] It is possible to use cure rate models to compare the efficacy of different treatments.[7] Generally, the survival curves are adjusted for the effects of normal aging on mortality, especially when diseases of older people are being studied.[8]
From the perspective of the patient, particularly one that has received a new treatment, the statistical model may be frustrating.[6] It may take many years to accumulate sufficient information to determine the point at which the DFS curve flattens (and therefore no more relapses are expected). Some diseases may be discovered to be technically incurable, but also to require treatment so infrequently as to be not materially different from a cure. Other diseases may prove to have multiple plateaus, so that what was once hailed as a "cure" results unexpectedly in very late relapses. Consequently, patients, parents and psychologists developed the notion of psychological cure, or the moment at which the patient decides that the treatment was sufficiently likely to be a cure as to be called a cure.[6] For example, a patient may declare himself to be "cured", and to determine to live his life as if the cure were definitely confirmed, immediately after treatment.
Cures can take the form of natural antibiotics (for bacterial infections), synthetic antibiotics such as the sulphonamides, or fluoroquinolones, antivirals (for a very few viral infections), antifungals, antitoxins, vitamins, gene therapy, surgery, chemotherapy, radiotherapy, and so on. Despite a number of cures being developed, the list of incurable diseases remains long.
Scurvy became curable (as well as preventable) with doses of vitamin C (for example, in limes) when James Lind published A Treatise on the Scurvy (1753).[10]
Antitoxins to diphtheria and tetanus toxins were produced by Emil Adolf von Behring and his colleagues from 1890 onwards. The use of diphtheria antitoxin for the treatment of diphtheria was regarded by The Lancet as the "most important advance of the [19th] Century in the medical treatment of acute infectious disease".[11][12]
Sulphonamides become the first widely available cure for bacterial infections.[citation needed]
Antimalarials were first synthesized,[13][14][15] making malaria curable.[16]
Bacterial infections became curable with the development of antibiotics.[17]
Hepatitis C, a viral infection, became curable through treatment with antiviral medications.[18][19]
Just a few years after the first antibiotic, penicillin, became widely used in the late 1940s
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