Meet Dan Hurley, Author ofTuesday, March 02, 2010
Meet Dan Hurley, Author of Diabetes Rising
Interview by Mike Boyle
Dan Hurley (pictured), author of the new book, Diabetes Rising/How a Rare Disease Became a Modern Pandemic, And What to Do About It (Kaplan), is also a science writer and journalist who regularly contributes to The New York Times’ Science Times. He also writes for numerous medical newspapers, including Neurology Today (the newspaper of the American Academy of Neurology), Gastroenterology and Endoscopy News, Pharmacy Practice News, General Surgery News, and others. He has been a senior writer at the Medical Tribune and contributing editor to Psychology Today, where his article on the violently mentally ill won the American Society of Journalists and Authors’ award for investigative journalism in 1995. He is the former Vice President of the American Society of Journalists and Authors. Hurley is also the author of Natural Causes: Death, Lies, and Politics in America’s Vitamin and Herbal Supplement Industry and The 60-Second Novelist: What 22,613 People Taught Me About Life.
What follows is an interview DiabetesCare.net managing editor/webmaster Mike Boyle recently conducted with Hurley about his new book. Hurley himself has lived with type 1 diabetes for over 30 years.
Mike Boyle: Why did you want to write this book, and how did go about assembling the content for it?
Dan Hurley: This is not an idea I had; I was approached by an editor who said that there has not been a good narrative investigative journalistic look at diabetes and that everything else out there is just of the “self-help” and “how to” nature.
At first I felt that it would be nearly a lengthy Wikipedia version (laughs). I’ve had type 1 diabetes for about 35 years, and have been a medical journalist for over 20 years and I feel like we all know the rap about diabetes. And basically I wasn’t very interested in doing the book until I started snooping around and looking into things. I ended up finding out a lot of stuff that really surprised me that I had never heard of, and it disturbed me. I still think the diabetes establishment needs to grapple with a lot of things and patients need to know about the things I talk about in the book.
MB: How did diabetes - as you claim in your book’s title - become a modern pandemic? And without revealing too much from the book, what can people do about it?
DH: We all know most of the type 2 story; people have eaten their way to it. We spent a millennia dreaming of getting milk and honey on the other side of the Jordan River and when we got there we started eating it and we all got type 2 diabetes (laughs).
What really surprised me is the fact that type 1 diabetes is also dramatically rising and it seems to be doing it less in sync with type 2 diabetes. This has been a story that you can see in the medical literature; there is a lot of studies. But for some reason I just don’t think it resonates with the media; it doesn’t fit that “obesity” story that journalists think they know, so the fact that type 1 is rising is really peculiar and that is what really hooked me and got me fascinated and determined to learn more about it.
And type 1 being on the rise has nothing to do with my opinion. Basically, in country after country – and this has been documented around the world – type 1 used to be profoundly rare and the rate of it is now 10-20 times higher than it was about 100 years ago. And it is five times higher than it was in the 1950s and twice as common as it was in the 1980s. This is not due to genes; it’s not genes that are changing. In fact fewer and fewer people with type 1 now have the genes that have been shown to be associated with an increased risk of developing type 1. So there is just a host of data and most of it comes now from the Centers for Disease Control doing a very careful study called “Search for Diabetes and Youth.”
MB: I love this question posed on the inside cover of your book: “Why didn’t my doctor tell me about that?” Is it fair to say you are throwing the gauntlet down to challenge today’s doctors to become more educated in an effort to help their patients understand and manage their disease?
DH: Doctors are not public health officials for the most part; you come in when you are sick and they give you something to fix it. So the problem with that model for both kinds of diabetes is just not working. If I have type 1 diabetes, you give me insulin and you send me on my way. If I have type 2 diabetes, you tell me to stop eating so much and to start exercising and you send me on my way. However, I come back in three months and I tried that, but it only had a modest affect and you give me one medication…then two years later you are going to give me a second medication and five years later I’m likely to have the dose upped…and then 10 or 15 years up the road I’m on insulin and I’m gaining ever-more weight.
There are lots of great treatments for both kinds of diabetes, but the problem is that as both of these diseases are exploding and prevalent, we are not dealing with stopping this mushrooming epidemic. It’s as if people are getting measles and instead of saying, “Hey, what about a vaccine?” – medical professionals are just treating all the measles. The way that medicine can really make a difference in diseases is to stop them and prevent them from ever occurring and that’s what needs to happen with diabetes.
MB: You talk in the book about your experience with the “holy grail with diabetes” – an iPod like artificial pancreas that might be up-staged by SmartInsulin…Talk briefly about those two things.
DH: There is a company in Massachusetts developing SmartInsulin. The Juvenile Diabetes Research Foundation has been supporting them in research, as has the National Institutes of Health, and basically that is going to work or it’s not going to work. There are lots of drugs that people test – and they seem great – and then “oops” it doesn’t work, or it’s unsafe. So the only way we’ll know about that in the end is when all the testing is done and it gets approved by the Food and Drug Administration…and that will be amazing and totally miraculous! It would be like an artificial pancreas, except it is doing it itself. It basically only switches on when your sugar level rises and you need it.
On the other hand, the nice thing about the artificial pancreas is that it works. In fact you can almost say there is no way it can’t work. If you could take an injection of SmartInsulin, it would only start working when you sugar level goes high and it would just keep your sugar level perfect. With the artificial pancreas you’ve got to connect it to yourself and you have to monitor it. It’s never going to be perfect...Look at it this way: computers are really good at - well - computing and calculating (laughs); that’s what they do. But the big pain with type 1 diabetes – or type 2 if you take insulin – is that you are constantly checking, checking, checking and adjusting your insulin dose all the time. It’s maddening and nearly impossible for human beings to work effectively in those situations. The bottom line is, the computer is always calculating and deciding how much insulin you need automatically – that’s great. My participation in the [artificial pancreas] trial was a mindboggling experience, especially because anyone with type 1 diabetes has heard about this thing…for years. It’s kind of like when you hear about a cure for diabetes; after a while you get very cynical and you go, “Yeah right…and I’ll sell you the Brooklyn Bridge if you are willing to buy it!”
What’s crazy is that it [the artificial pancreas] really does work and they are so close to bringing this to market in just a few years…and it will save lives!
MB: What do you see as the biggest medical hopes on the horizon for people with diabetes?
DH: I think the biggest hope is not medical per say at this point. There are well over 20 drugs approved for type 2 diabetes. Have any of them stopped the disease from progressing? Have any of them lowered people’s risk of heart disease? Have any of them stopped the increasing numbers of people getting it? No…They are not doing that. So unless and until there is some real fundamental breakthrough in this field, they are not going to. We don’t need another drug to lower sugar levels; we’ve got nearly two dozen of them, and that’s not the problem.
People have been talking about a medical cure for type 1 diabetes like they are going to do a transplant, and there’s always something that doesn’t quite work because it is a fabulously complex disease that involves your immune system. The immune system is like a Rubik’s Cube; it is designed to work around everything you put in its path. I think where we are going to make progress is waking up and going, “Wait a minute…Another brilliant drug might not be the answer. Maybe what we need to do is figure out why both of these diseases – type 1 and type 2 diabetes – are in the realm of 20 times more common than 100 years ago, and what is driving that and how can we push those number around; what can we do?” That’s really what my book looks at; how can we turn around this global pandemic. It’s really stepping back and taking a look at the bigger picture.
MB: In the book you talk about how avoiding cow’s milk in baby formulas, getting adequate amounts of vitamin D, and simply "playing in the dirt" – can prevent many cases of diabetes…”
DH: All of those are working hypotheses. We don’t know yet whether any of these is true, whether all of these are true, or whether none of them are true. But what we do know is that there is something in the environment - something in the world we live in – that is pushing these cases up. Genes aren’t changing; we’ve got the genes we’ve got. So something is changing and the question is: what? Now there are lots of things that have changed in the world that we live in over the past 100 years, but there is a lot of good evidence that low levels of vitamin D - because we spend so much less time outside - might contribute to cases of diabetes.
Additionally, exposure in the first six months of life to infant formula - other than the hypoallergenic formulas that are believed to be protective - and that lack of exposure to all of the pathogens out there (the bacteria, the intestinal parasites and all these things our immune systems used to have to deal with and are no longer dealing with) might be playing a role in diabetes development. Lots of really smart people are working really hard to pursue this.
MB: I read a transcript of a recent interview you did on National Public Radio where you answered an email from a 35-year-old woman who felt her being diagnosed with pre-diabetes was like “living with a death sentence.” I loved your answer; would you share it with our readers?
DH: It is really hard to control diabetes; it really sucks…and a lot of my book is about that. What we need to do is move past dumping controlling the disease on the shoulders of the diabetic and shaking our finger at them and telling him or her to try harder. That’s just not working…On the other hand it is really important if you have diabetes to wrap your head around the fact that you can do a lot to make this disease livable. It is not a death sentence. I am 52-years-old; older than my father was when he died and he had type 2 diabetes. I’ve had type 1 since I was 18-years-old and I don’t have eye or kidney disease, or nerve damage, and my heart seems good. I even jog…The point is, I have done everything I have wanted to do my whole life including travel widely…Diabetes is just an annoyance, not a death sentence. You just have to come to terms with it and take the best care of yourself you can.