In contemporary philosophy, there are two basic concepts of evil: a broad concept and a narrow concept. A broad concept defines evil simply as any and all pain and suffering: "any bad state of affairs, wrongful action, or character flaw". Yet, it is also asserted that evil cannot be correctly understood "(as some of the utilitarians once thought) a simple hedonic scale on which pleasure appears as a plus, and pain as a minus". This is because pain is necessary for survival. Renowned orthopedist and missionary to lepers, Dr. Paul Brand explains that leprosy attacks the nerve cells that feel pain resulting in no more pain for the leper, which leads to ever increasing, often catastrophic, damage to the body of the leper. Congenital insensitivity to pain (CIP), also known as congenital analgesia, is a neurological disorder that prevents feeling pain. It "leads to ...bone fractures, multiple scars, osteomyelitis, joint deformities, and limb amputation... Mental retardation is common. Death from hyperpyrexia occurs within the first 3 years of life in almost 20% of the patients." Few with the disorder are able to live into adulthood. Evil cannot be simply defined as all pain and its connected suffering because, as Marcus Singer says: "If something is really evil, it can't be necessary, and if it is really necessary, it can't be evil".