World Health in a Time of Crisis

Dr. Katja van Herle courtesy of Mary Wells

Editor’s Note: Dr. Katja Van Herle is a professor of Medicine at the Scripps Research Institute in La Jolla, CA, where she heads the Community Outreach for Education Center (CORE). The division works to make a difference in people’s health and overall lives by educating them about basic science research. She’s also a clinical faculty member at the David Geffen UCLA School of Medicine, where she sees patients in a private practice, offering research knowledge to better their lives through a program called from “Bench to Bedside.”

Below is an excerpt of an edited conversation between Mary Wells and Dr. Katja Van Herle about the health-care crisis, the death of community medicine, the reality of an obesity vaccine and more

KATJA: … We know that this disease — and especially in children unfortunately – is plateauing in adults – Type-2 diabetes. But obesity and diabetes and heart disease is still rising faster than ever in our children between eight and 15 years old, especially young girls. There are probably a number of reasons for it. One is that we know that all children, right at the time of puberty, have what we call “insulin resistance.” What does that mean? You know how little babies kind of plump up right when they’re about to start walking? They kind of grow fat and then they grow tall, and then they start walking. Well, it’s funny because we do this just before we go through puberty and get the first menstrual cycles and so forth. Young girls are entering that period of natural physiologic insulin resistance, which means you’re a little bit pre-diabetic, if you will. They’re entering that too heavy going in. So what’s happening is that you’re seeing — because women tend to go through menarche earlier — we develop earlier in terms of our development than boys. Boys will develop years later, even from 15 to 18. But girls are developing between eight and 12. Well, they’re entering that eight-to-twelve range too heavy. And they’re heavier than the boys at that age. And so we feel that then the natural insulin resistance is actually made even worse. You know, women have a higher percentage of fat. We have that on our bodies. That’s how we can have babies. That’s part of child bearing. So, unfortunately, young girls are taking a hit here.

So is McDonald’s getting a bum rap? They’re getting a bum rap in the sense that — and I’m not a hired gun for McDonald’s Corporation, we work with other corporations — they’re getting a bum rap because no one entity should take the blame for this. This is a societal problem. It has everything to do with the fact that both parents are out working far too many hours, no one can buy fresh fish and fresh food anymore. It’s not happening. There’s no time in the day for it. It’s becoming more and more expensive. Now with gas prices, I can tell you, people aren’t doing their daily shopping all the time. They have to go to places like Costco. And when you bulk up and buy all that, what you’re buying is food with a long shelf life. So, to me, if you target one company, and they are the biggest – by far bigger than anyone else in that world of quick service restaurants – if you target one company, it’s a Band-Aid. You’re not going to get to the solution. You’d have to look at everything from getting physical education put back into schools, like one of the programs we’re doing; understanding the science of why people actually make more fat cells when they have the genes for Type-2 diabetes, that’s the science that we’re doing. And then you have to get into the clinic with the new medications and changes that we know can actually stop this process right away.

MARY: Are there new medications?

KATJA: Yes, there are actually. We’ve got some really good ones. We have new methods now where we are understanding how insulin is secreted with other hormones. We now can mimic those hormones in injectable forms, some in tablet forms. But it’s not insulin. It’s actually co-secreted with insulin. So what we see is that these other hormones — which are also made with insulin at the time of a meal — these hormones actually cause feedback back to the brain to stop hunger. And that allows people to lose weight. And, in fact, it also sends signals to the stomach and the gut. So what we’re seeing in this new generation of drugs is that we are really, again, understanding the basic science and able to not only get someone’s blood sugar down without having to give them an insulin injection, for instance, but you actually are returning normal physiology. And that’s available in the clinic. And that’s why Big Pharmaceuticals is so important.

MARY: If those products can actually affect your thinking about eating and your hunger, wouldn’t people who wanted to go on a diet use them?

KATJA: Well, believe me, that’s being studied now to see if that can actually help, in general. Too much of anything is a bad thing. Moderation is the key to life. It applies to everything. It’s not everything and it’s not nothing. It’s what my husband, David, always says — the theory of justs. You have to have just enough. And I really like David’s theory. He says it’s like with money; with food, if you don’t have it you suffer. If you have too much, you can also suffer. And that theory of justs is so important in our campaigns, in our education campaigns. So I think that, again, I’ve just told you there are some new medicines out; there are newer ones coming out. Why is this so important? Because you see, if you’re at a basic science center, you understand then what’s being developed, how quickly it can get out there. If physicians in the clinic can no longer have time for teaching and doing research, how much time do you think they have to educate themselves continually? They don’t. They see 25 patients a day. Pediatricians are seeing sometimes 40 children a day. So how much preventive healthcare and screening can they do?

MARY: How do they learn?

KATJA: They have to go to continuing medical education programs and seminars. So there are so many hours a year you have to do.

MARY: They don’t do that …

KATJA: They do it. If they’re neurologists they’ll go to the annual neurology conference. I’m an endocrinologist so I went to San Francisco for four days to the endocrine society meetings. They do that, but you do it for four days in one year. And I don’t want to imply that clinicians aren’t reading. I’m saying that they can’t dig very deep. It’s very superficial and cursory for most of us that don’t have access to a basic science center. You know, what is really worrisome is that the level of health care, even in big centers that do have research, education, a medical school and clinical care – that level of care is dwindling down. Now go into a community where there’s only one endocrinologist, for instance, for I don’t know how many million people. And they’re nowhere near. You have to drive two hours. This is where we’re going. Community medicine is dying; it’s tanking, actually. So one of the things – again, one of the reasons that I say we’re public health advertisers is what I do, I hope, is try and take the best of these three arenas – education, clinical care and research – and build public education programs.

The company that I founded is a not-for-profit; it’s called Greater Good Fund. It’s a foundation piece that basically is a public health advertising company. That’s what it is. So, we work with charitable foundations, families that have a sick member that maybe want to invest and look at a disease like multiple sclerosis. We work with big corporations, like McDonald’s. We work with other big corporations. And what we try and do is, again, get the biggest microphones we can nationally, whether we go to the National Academy of Sciences in Washington, we talk to senators, we talk to movie stars. And we say, “Look, there’s a disease out there. We have a program, we have a targeted group we want to start teaching – 39,000 school kids that need to get PE back in their schools. We ask them to put money in. No one gets rich on this, except the wealth of good health through prevention. So I think it’s trying to take the old model of the old-fashioned system of how doctors were trained and scientists were brought up, and go back to it. But it’s kind of a one-man show right now because it’s hard to do, because financial reasons, you’re basically wearing a lot of hats and people, because there is really, unfortunately, an epidemic of  attention deficit that we’ve all got – and I mean globally, as a whole society and the worldwide society. We just have such a hard time waiting patiently for long-term outcomes. And health care is a long-term outcome. Education is a long-term outcome. Elderly care is a long-term outcome. We’re just not able to do it any more as a society. It’s not entirely our fault. We’ve been bombarded with so much stimulation that what ends up happening is, we are expecting so much stimulation. People have BlackBerries. You’re doing e-mails in the car. You’ve got multiple ways of getting so much information back so quickly that you start, unfortunately, rising to the occasion.

And why it’s so unfortunate is because diseases, again, are diseases. They haven’t changed. There’s still cancer. There is still demyelinating disease and Alzheimer’s and there are still all these things out there. And it’s still the old tried and true way of preventing early on the long-term patients; putting in the dollars for the preventive screening programs that are going to stop these diseases from becoming epidemics. But we can’t seem to batten the hatches down. We can’t seem to stick to it anymore. Everyone wants it now.

We have a project that we’re working on – one of our researchers at Scripps Research – obesity vaccine. Now, the obesity vaccine is a very interesting vaccine. But here’s an example of everyone wanting it now. Big pharm is so interested in trying to buy the licensing from the work and all that, and that’s all wonderful. But you and I both know where that’s going to go. If they’re having the successes, once they do human clinical trials, they think people are going to want it because they’re still going to be eating. But they’re going to want it because they’re going to say, “Well, this is a way I can quickly solve it,” right? Magic bullet. There are no magic bullets – very, very rarely. And so, it’s almost like I think what’ll end up happening, and this sounds very pessimistic — our researcher would not like to hear this — is that the vaccine will possibly not have the outcomes it needs to once it gets, let’s say, into a public arena for people to use, because they’re going to keep eating, and overeating. But they’re going to think they’re safe because of the vaccine. So it almost becomes, all that work becomes moot. Again, you’ve got to put the investment in.

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