The real-life inspiration and the medical accuracy
The 2019 film Five Feet Apart captivated audiences with its story of two teenagers, Stella and Will, who fall in love despite being forced to stay six feet apart due to their illness. While the movie is a work of fiction, it is deeply rooted in the realities faced by people with cystic fibrosis (CF). The movie's director, Justin Baldoni, was inspired by the life of Claire Wineland, a YouTuber and CF patient who served as a consultant for the film. Her candid videos brought awareness to the daily struggles and emotional toll of living with a terminal illness.
However, the film also sparked controversy within the CF community regarding its accuracy, particularly the titular 'five feet' modification of the actual 'six feet' rule. For CF patients, cross-infection from bacteria passed between individuals with the disease can be deadly. While the movie took some artistic liberties, the core struggle—the longing for human connection while being physically separated by a chronic illness—is a poignant and authentic aspect of the CF experience.
What is cystic fibrosis (CF)?
Cystic fibrosis is a progressive, genetic disease that causes thick, sticky mucus to build up in the body's organs, primarily the lungs and pancreas. This buildup leads to severe breathing problems and serious digestion issues, as the mucus can block airways and ducts.
How CF affects the body
The defect in the CFTR (cystic fibrosis transmembrane conductance regulator) gene is responsible for the disease. This gene controls the movement of salt and water in and out of the body's cells. When it malfunctions, the result is abnormally thick fluids.
- Respiratory System: The thick mucus clogs the airways, making it difficult to breathe. This trapped mucus also becomes a breeding ground for bacteria and fungi, leading to chronic and often life-threatening lung infections. Over time, these repeated infections can cause permanent lung damage.
- Digestive System: The mucus can block the tubes that carry digestive enzymes from the pancreas to the small intestine. Without these enzymes, the body cannot properly absorb fats and proteins, leading to poor growth and malnutrition.
- Other Systems: CF also affects other parts of the body, such as the liver, sinuses, and reproductive system. In men, CF can cause infertility, while women with CF may experience reduced fertility.
The evolution of CF treatment
Historically, the life expectancy for individuals with CF was quite low, with most not surviving past their teens. Thanks to significant medical advancements, the prognosis has vastly improved. Today, people with CF are living longer, healthier, and more productive lives, with a median life expectancy now around 50 or older for those born recently.
Key aspects of CF treatment include:
- Airway Clearance Therapy (ACT): These daily techniques help to loosen and remove the thick mucus from the lungs. This can involve using vibrating vests, special breathing devices, or manual chest physical therapy.
- Medications: A range of medications are used, including antibiotics to fight infections, mucus-thinning agents like hypertonic saline, and anti-inflammatory drugs.
- Nutritional Support: Many people with CF require pancreatic enzyme supplements with meals to aid in nutrient absorption, as well as a high-calorie diet and fat-soluble vitamin supplements.
- CFTR Modulators: The development of CFTR modulator therapies represents a major breakthrough in CF treatment. These medicines directly target the underlying genetic defect, helping the faulty protein function more effectively. A triple-combination therapy, for example, is effective for the majority of people with CF.
- Lung Transplant: For individuals with severe lung damage, a lung transplant can be a life-saving option.
The reality versus the film's portrayal
To understand the full scope of CF, it's helpful to compare the medical reality with the dramatization seen in the movie. This comparison highlights both the film's educational impact and its potential for misrepresentation.
| Aspect | Movie Portrayal | Medical Reality |
|---|---|---|
| The 'Six-Foot' Rule | The characters purposefully break the rule, moving to five feet apart for romance. | The rule is a critical, strict guideline to prevent the spread of dangerous, multi-drug resistant bacteria between CF patients. Breaking it carries a significant, life-threatening risk. |
| Sickness Severity | Stella and Will are often shown in a state of crisis, focused on their illness. | While CF is a serious illness, many modern patients live active, full lives and are not constantly in a state of severe health decline, especially with the effectiveness of new treatments. |
| Patient Interaction | The romantic plot is central to the movie's narrative. | Many CF patients consciously avoid others with the disease to prevent cross-infection, often relying on online communities for peer support. |
| Lung Transplant | A lung transplant is presented as a dramatic, last-ditch hope for survival. | While a transplant is a life-saving procedure for some, it is a complex process with its own set of risks and long-term management challenges. |
The impact of awareness
Despite the controversy over some of its artistic choices, Five Feet Apart played a significant role in raising public awareness of cystic fibrosis. For many people, it was their first exposure to the disease, which helped shed light on the daily struggles and emotional complexities of living with a chronic, life-threatening illness. The movie encouraged conversations about the disease, and the broader discussion ultimately served to benefit the CF community by increasing visibility and potentially fostering greater support for research. For more information on CF and its impact, explore resources from the Cystic Fibrosis Foundation.
Conclusion: Beyond the screen
While Five Feet Apart uses cinematic drama to tell a compelling love story, its foundation is a very real and serious disease. The film successfully highlights the emotional and physical barriers faced by people with cystic fibrosis, while also revealing the life-affirming search for love and connection, even under the most difficult circumstances. Understanding the disease behind the story provides a deeper appreciation for the real-life struggles and triumphs of the CF community, a community that continues to push for better treatments and a cure.
