Introducing Francine Kaufman: Newest Member of Science Advisory Council
Meet Francine Kaufman M.D., the newest member of the Beyond Type 1 Science Advisory Council! Dr. Kaufman recently spoke with Beyond Type 1 about her history of treating diabetes, her work abroad, the global diabetes landscape, and the future of T1D.
Tell me about your decision to practice medicine and specialize in endocrinology
I always wanted to be a doctor. The family legend is from the time I was 4 years old, I was committed to being a doctor. I would play the role of a doctor as a child and I was always interested in science and math. I went to Northwestern University where I was already committed to be premed. Then, there’s always a decision once you’re in medical school — What do you actually want to do? That’s where it becomes hard. I had a grandmother who had Type 2 diabetes when I was little. She took insulin and I was always fascinated by her shots. At that point we were boiling syringes and sharpening needles. And I actually began participating in her insulin therapy, actually as a little girl. So I think I always had an eye on endocrinology.
And then during my training, one of my first attendings at Children’s Hospital Los Angeles, was an endocrinologist. He was just so knowledgeable, and it was so fascinating that I decided during my internship, very early on, that I wanted to go into endocrine. For a while I did all of endocrinology, but diabetes was always my favorite. I did some clinical research, some basic research in glucose and galactose metabolism, and even got into public health research on the food environment in schools — I don’t regret any of it.
How has our understanding of diabetes and diabetes management changed from the time you started practicing medicine?
I’ve been practicing almost 40 years, since the start of my fellowship. At that time, all we had was animal insulin and urine testing. And we hadn’t proven that glucose control matters. So I’m old, I’ll admit it. I’m proud of it. In my own career lifetime, we’ve gone from that beginning to a very different place, particularly for Type 1 diabetes. On the insulin front, there have been innovations around insulin analogs, and on the insulin delivery front— pens and pumps, and pumps that can automate insulin delivery. Then, there’s obviously been progress on all aspects of our understanding of the pathogenesis and the long term course of diabetes. We understand the complications much better. So we’ve come a really long way. We’re not at the end of the journey yet, but we’re getting closer.
Can you tell me about working on the MiniMed 670G?
I had always been very interested in technology and diabetes management, but got especially excited about the possibility that we could really develop a device that could automate insulin delivery. Medtronic was in the midst of all of those investigations for quite some time. In 2009, I came to Medtronic to be the Chief Medical Officer and Vice President of Clinical, Medical and Health affairs, and worked on the finalization of the devices and the algorithm. It was a huge team that was incredibly committed and knowledgeable. They helped with the clinical trial design and the interactions with the FDA, which were also phenomenal. I got to see the clinical data, as well as the impact in the real world, which we’re now witnessing. It was a phenomenal privilege to watch this next innovation in diabetes care, and to have participated in it.
As I am giving this interview, I have announced that I plan to retire from Medtronic Diabetes. It has been a most glorious ten-year experience for me and I feel so privileged to have worked with so many brilliant, committed, focused and caring individuals at Medtronic. I went to bring closed loop to market, and I couldn’t be more thrilled with that accomplishment. It breaks my heart to leave. I am going to take some time off and see what the next chapter of my life will be.
Are you surprised by the growth of the diabetes industry? Did you imagine when you started working that there would one day be so many different companies contributing to helping with the treatment, and working towards a cure for this disease?
I think it’s great. Obviously, there are a lot of scientific interests. There are a lot of industry interests. I think there is a lot of interest from those with diabetes and their family members to continue to advance therapy. And so in that kind of milieu, there are more and more people entering the field, which helps everybody. It keeps everybody on their toes, gets the best product out there, and it’s just been exciting to see that explosion. When I started my career, there were one or two insulin syringe makers and two or three insulin companies, and there weren’t even BG meters. Now there’s been a proliferation from pens to pumps to sensors. All that is pretty amazing and serves to benefit people with diabetes.
Tell me about the work that you’ve done abroad — Why is global access to diabetes medication and technology important?
I was privileged to be at Children’s Hospital Los Angeles where we focused externally very early on. My first trip to do education and training in a low-resource country was to Mongolia in the 90s. It was an interesting experience to be able to see what the past was and how privileged and fortunate we are in the developing world to have so many advances that seem like a remote dream in other parts of the world.
I think that really started my interest. I went to China and Ecuador with my husband, Neal. We went to Ecuador originally with AYUDA to help them with their first camp, and from there we just got more and more committed. We worked for years in Haiti — where we provided education to the healthcare providers, nurses, dietitians, community health workers, and some of the lay public. We had a camp there for children with diabetes for a number of years.
This last year we went to Ethiopia with Life For a Child with Graham Ogle. We went to help train Health Care Providers for Life For a Child and the clinics that follow children in the program. The goal of Life for a Child is to bring life-saving therapy to children in low-resource countries where it is very difficult to get access to supplies and care.
How has the global diabetes community evolved from the time when you began practicing?
There was always the International Diabetes Federation. The American Diabetes Association, which I was fortunate enough to be president of in 2003, also had an external focus. I got to go to India to a large joint ADA – India Diabetes Association effort on training and educating care providers. There is Insulin For Life, particularly Insulin For Life USA, which is run by the Atkinsons, Carole Atkinson in Gainesville, where they’re gathering supplies and being a supplier for many low-resource countries, as well as disasters when they occur. Insulin for Life brings together the diabetes community, and of course they’re working with JDRF and the ADA, and some of the federal agencies to be sure that these supplies can get where they’re needed.
Life For a Child, perhaps one of the most amazing programs, is now supporting over 18,000 young people in low resource countries across the globe. Most of the children that I’ve been involved with over the years have been in the Life For a Child program. So that’s the most amazing program and of course supporting them enables children to stay alive with Type 1 diabetes. There really is a lot of international collaboration and a lot of international focus. However, we are lucky if we can just get the basics to developing countries, and right now it is only a dream that we can one day get them the advances that are available in the developed world.
Can you talk about the importance of representation in the diabetes landscape?
When I started in medical school, it was 10% women, maybe a little bit more depending on what school you went to. Even pediatric residencies were 25% women. Now they’re almost exclusively women. Now just over half of medical students are women.
I think everybody appreciates how important it is to have women in leadership, that leadership skills and styles are a little bit different between men and women. All diversity, from gender to LGBT to ethnic racial diversity is really important, particularly in a field like diabetes where we’re trying to ensure we hear the voice of the patient. It’s easier when you have a diverse workforce in industry, academics, and in clinics, wherever it may be — A diverse workforce can understand the diverse population that we have in our world. And we are richer because of it.
Although there are a lot of women in medicine, there are still not enough in leadership positions. Often early in my career, there would be only one woman in the room, kind of the token women in some of these higher-level meetings. It was a brilliant concept because what it got was women competing with each other rather than women having to compete with men, which I think we do rather well. Those days are over.
Can you tell me a little bit about your relationship with Dr. Lois Jovanovic?
Two weeks ago, I was at her celebration of life. I got to give her eulogy, remembering and celebrating her legacy as a true pioneer in the field. She was a very, very strong voice, somebody who moved the metrics, developed standards of care, and enabled tens of thousands, if not millions of babies to be born healthy. We should all celebrate a legacy like that and appreciate what she was able to accomplish while she was with us. We were good friends for decades. I think we were maybe on one of the first MiniMed advisory boards together. We go back a long way — we didn’t always agree on everything, but as matter of fact, we loved disagreeing. Being with Lois, was always great fun.
Tell me about your work with Type 2 diabetes
I got involved in Type 2 diabetes as a pediatric endocrinologist, when it became apparent that Type 2 diabetes was occurring in youth across the country, across the world. When I started my career, we did not have something like an obesity clinic at Children’s Hospital Los Angeles. By the late 80s, early 90s we were seeing the beginning of the obesity explosion in children. Then obesity clinics developed, and they turned into Type 2 diabetes clinics.
I was very interested along with a lot of other people, some real leaders in the field, to try to determine what was causing the rise in childhood obesity. Obviously, it’s a whole host of issues coming together that span the life cycle, from exposure to diabetes during fetal life, to changes in infant feeding practices, more and more women not nursing, to changes in how we market to children, so that by age 2 they know what McDonalds is. I watched the food environment of our schools, childcare centers, and preschools deteriorate in my own lifetime, with school lunches and vending machines selling sodas.
It was clear — what was affecting adults was also affecting children — it was a shift, in part, in the social economic and ecological environment that children were being exposed to: where they and their parents lived, worked, played, learned. I got particularly interested in the soda issue. In 2003, I was one of many, many people who helped bring to the fore of L.A. Unified school board, the detriment of vending sodas on middle school and high school campuses. We ended up, after much debate and data and everything else that needed to happen, having the LA Unified School District, the second largest in the country, ban sodas in schools. That was kind of a monumental issue.
What are you excited about for the future of diabetes treatment?
I’m excited about the continuation of technology advancements. I’m excited about Closed Loop. I’m excited about the first implanted sensor, just kind of all the innovations on the technology front. On the human side, I’m really excited about the impact social media has had. The ability for people to really come together and help define what they want, and the ability for the voice of the patient, the voice of the customer, to really be heard. I think that’s really helped move the metric. I’m excited about advancing insulins, and the emergence of adjunctive therapy for people with Type 1. I’m particularly excited about the first congresswomen with Type 1 herself, who’s also a pediatrician, Kim Schrier, from outside Washington. She was a babysitter for my kids. She was one of my patients, and she was one of my students. I think we’re going to have a really great voice in congress with her.
And I do believe, I’m really hoping, there can be a cure while I still walk on this planet. I think there’s a lot of opportunity, lots of science, lots of collaboration, and a lot of focus on curing Type 1 diabetes.
Are you excited to join the Beyond Type 1 Science and Advisory Council?
I think what you guys are doing is phenomenal — Nick Jonas’ involvement, and the high profile that you guys have been able to have is just incredible. I think it really makes a lot of difference for bringing awareness of what it’s like to have Type 1 — how important it is, that it has the commitment it needs from the entire ecosystem, and just that we’re able to keep moving forward.