Dan Hurley is a journalist and science writer who contributes regularly to the New York Times. He's also written for the Medical Tribune and Psychology Today. And he's one of us PWDs. His new book, Diabetes Rising, is an exposÃ© on the academic world of diabetes, coming out January. Have a look at last week's 'Sneak Preview' of the book.
When I talked with Dan recently, he had so much good stuff to share that I felt — for the first time ever — that the interview warranted a two-part series. Today: Dan on cures, vitamins, and what the ADA is not doing right.
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DiabetesMine) Diabetes Rising is probably the best overview I've ever read of the evolution of diabetes care and research. How long did it take you to research, and what drove you to do it?
Dan Hurley) In one sense I spent a full year researching and writing it; in another sense I've spent 34 years researching it, because I brought my experience of having diabetes, and being reporter having listened to the advice and information given to people with diabetes for so many years. I was there when the DCCT results were presented, for example.
Undoubtedly the major driver in how I approached the book is the feeling that something is missing in what people with diabetes are generally told. I follow all the recommendations for testing blood glucose and doing the best you can. Even with this best medical advice, I feel that the 'just try harder' approach is not going to work for a lot of people. If you're very educated, motivated, and have a good attitude, you can kind of stumble your way through it. But obviously tons and tons of people don't have all those attributes... something else is needed to help them.
So you were diagnosed 34 years ago?
Yes, I was 18. I was in my first semester at Beloit College in Wisconsin. I was half a continent away from my family — and I thought I knew it all... but it was challenging. I don't think there's a good time to be diagnosed, but the start of college is certainly not a good time. They say it's worse if you're a teenager. But I was away from home and didn't get the benefit of someone telling me what to do, even for a little while. I barely got any instruction at all. It was just 'here's your insulin, here's your sliding scale, and some information about diet. Follow this, and you're going to be fine.' The fact is, unless you live an extremely predictable life in terms of food choices and activities, it's really quite complicated. I was quite afloat for a while... Nowadays I use a pump, the Medtronic Paradigm with the integrated continuous monitor system.
In the book you quote Judith Fradkin, director of the Diabetes Division at NIDDK, as saying that she wouldn't be surprised if all the current hypotheses about what causes diabetes were wrong. Isn't that maddening? Where does that leave us?
You know, if I were just in it for the money, I would write a sensationalist book saying that X or Y is the reason, like the "New Diabetes Revolution" — and then get some Billy Mays type to sell it. But the only way to know if a hypothesis is right is to prove it...
I don't think there's much doubt among experts that early growth increases chances to develop Type 1. Essentially humans are getting taller, bigger, growing faster. You can see it when you look at the size of people from 100 years ago. The accelerator hypothesis says that our systems are being overtaxed — as greater demands are put on the pancreas, it stresses the immune system. Also, we're not getting any of these illnesses kids used to get. We're growing like there's no tomorrow, and eating a rich diet, with vitamin supplements, etc.
There's not much doubt either that Vitamin D is preventative. There's an astonishing array of evidence that it does good — it's associated with preventing all these cancers — and doesn't seem to cause any harm.
I think governments need to take better stock of health needs for Vitamin D. With all the fuss made over Vitamin C, initiated by Linus Pauling... I think maybe he was just one letter off.
But aren't people getting plenty of sun, especially in certain parts of the world? And who's going to slow down human growth?
I think people are slathering sun lotion on, they're afraid to spend time out. And kids spend less time outdoors, more on the computer. Our national parks are being used less. Vitamin D is certainly not the one and only thing going on, but what's beyond dispute is that it's playing a role. The extent of role has to be sorted through...
Of course, nobody's going to start starving their kids... I think Judy Fradkin is saying that these are really complex questions. They're not yet answered, and the history of medicine is riddled with things that seem like a slam dunk until someone does a large randomized clinical trial. Like woman's hormone replacement therapy. It seemed so obviously effective, but then the results came out and it turned out to be doing all this harm.
Honestly I think that of all five of these theories, POP (persistent organic pollutants) is the least strong. Pollutants can do harm, of course, but scientists themselves not convinced of exactly what, or whether these contaminants are being passed down through generations.
You don't say it outright, but it's clear in your book that the American Diabetes Association is NOT at the center of these advances. Are you dissing the ADA?
In their history, there's been a lot of hot air. They've certainly looked out for the interests of doctor's treating people with diabetes, but I haven't seen them at the forefront of advances for patients.
The ADA is a very conservative organization, and they admit that; they're even kind of proud of it. Anything that happens goes into a committee and comes out 5-10 years later. Sometimes it seems like they embrace things just as they're being proven wrong.
For example, they originally promoted a high-fat, high-protein diet. They were scared of carbs. Then in the '70s, with the big whole grain movement, they slowly embraced a high-carb diet. Later they fought against Atkins. They resisted low-carb recommendations for people with diabetes.
Yes, and the ADA is the biggest national advocacy organization. You fault them for focusing on self-management. Shouldn't they be doing more towards cure research?
I agree that they have left a lot to be desired. If you read the book, where is the ADA on all this? The rise of Type 1 is very concerning. Why hasn't the ADA made noise about that? They've also sat back during rise of fast food.
I really fundamentally question the view: 'You know folks, if you would just choose wisely at the grocery store, watch your weight, test your sugars, and there's all these drugs... you're in the driver's seat.'
I think what the ADA is saying is all true: watch your diet, test your sugar, try harder. That's what we've all heard... But Type 2 is so pernicious. It's hard to tell people not to eat. And too many people follow the advice (which is hard!) and they still don't get the desired results.
The ADA needs to get beyond the idea that the only two things to focus on are food and drugs. People are people. We're not robots.
And then there are the celebrities with diabetes who are coming out and saying one thing, and doing another. They're not out there saying, 'This thing is a disaster. I cheat, but you can't call it cheating because I do it every day.'
I don't see the ADA really shaking things up... there's a lot of advocacy that could be made beyond funding the NIH — which is important — and beyond telling PWDs to eat better and test more often.
Tune in Thursday for Part 2 of my interview with Dan: on the artificial pancreas and other new D-technologies, and his national call-for-action.