America's Health and Research Landscape at Stake

00:00:00: Diabetes Insights, Breakthroughs and Innovators.

00:00:04: The EASD TV podcast from the annual meeting of the European Association for the Study of Diabetes.

00:00:13: One of the themes that's constantly been bubbling through all the programme at DASD this year is the need for diversity when thinking about diabetes And diversity particularly DEI.

00:00:29: diversity, equality and inclusion was very much on the minds of the editors of Diabetes Care.

00:00:37: And they penned an editorial on it which has really sparked a lot of comment.

00:00:42: so I'm delighted to have with me its editor-in-chief Stephen Kahn and one of his deputy editors John Buse.

00:00:50: So why did you feel the need Steve?

00:00:52: To pen such a strong editorial about diversity?

00:00:59: So Vivian, thanks for having us both.

00:01:01: At Diabetes Care the journal that we've been involved with for the last couple of years We have felt it was important That we not sit back and just produce great science but also to look at The whole world of diabetes And ADA meeting just held in June, we had a symposium entitled Hard to Fix A Broken Healthcare System because we believe the American healthcare system is broken at all levels but particularly for people with diabetes.

00:01:30: And so once that symposium was completed We wrote this editorial which is now online and will be coming out on the print issue With other papers that came out of that symposium

00:01:42: And you've been really quite strong about this.

00:01:46: Just give us a flavor of the editorial?

00:01:49: Well, it was highly focused on sort of the political landscape in Washington DC currently and particularly concerns about cuts in health care budgets, particularly for the poor cuts in science funding, particularly at the NIH and CDC.

00:02:14: Concerns about threats against organizations nonprofit organizations that they might lose their tax exempt status based on speaking out around issues.

00:02:33: We just wanted to call attention to the fact that these issues were going on and they really constitute a threat... ...to health and well-being of everybody in the United States.

00:02:45: And frankly, the rest of world at least is being attacked by science in the US.

00:02:52: One particular thing I mentioned about diversity because we've had it again how it's so important to understand all the variation that there is in diabetes.

00:03:06: And yet, there has been this huge push against DEI which just as a kind of blanket... ...which has gone everywhere and yet its desperately inappropriate in diabetes care?

00:03:21: Yeah absolutely!

00:03:23: The way John said the US government was going about is not going to enhance the care of people with diabetes, never mind the care everybody in the United States.

00:03:32: So we can talk about funding.

00:03:35: but you also see proposed that big beautiful bill that's now being signed into law proposes major cuts and Medicare at least in Medicaid which really trying get rid of Obama's Affordable Care Act by decimating healthcare for to people who really need support in terms of their health care.

00:03:54: But other things we've seen the secretary of Health and Human Services do that I'm sure many, if you are aware of is just changing the makeup on a panel that's responsible for vaccinations.

00:04:04: he has also decimated United States preventive task force service which makes recommendations what should be done to people and have stacked these organizations with our own people.

00:04:15: And The United States has withdrawn from World Health Organization And then add to that all the reduction in foreign funding, which countries do not have really need to tackle problems like diabetes.

00:04:27: All of this is happening so it fits exactly with what John says.

00:04:32: It's everyone being hurt by US government currently doing and we felt was important call the South

00:04:39: Maybe I just added you know focus on sort of anti-diversity efforts In the beginning was very unfocused.

00:04:49: And one thing that I'm glad has been clarified and may not be known to all of our constituents in the United States or around the world is they have clarified, but will fund research focused on finding ways to move forward enhancing health equity but not efforts that are exclusively focused on descriptive analyses of diversity and health outcomes.

00:05:27: So the curious thing is, JFK

00:05:32: Jr.,

00:05:33: who's the Secretary of State has come in with a mandate related in particular to chronic disease.

00:05:41: So you'd think with chronic health conditions as his stated major focus that actually diabetes would be right up there, something worth of funding and worthy effort trying to prevent and halt it.

00:06:00: so how are those things misaligned?

00:06:04: Well I think a lot.

00:06:06: What has what is said?

00:06:08: it's said one day and denied another.

00:06:10: so a secretary Kennedy as an example Has done exactly, which he said you can deal with chronic diseases But his focus has been autism in vaccination.

00:06:19: That's all we hear about.

00:06:20: And changing the makeup of organizations.

00:06:24: So It's just not happening that way.

00:06:26: and then The Trump administration had proposed basically cutting the NIH budget by fifty percent.

00:06:33: Which?

00:06:35: representatives of capital who are not going to accept.

00:06:38: And I understand why, if you cut the biomedical research budget by that amount your constituents aren't gonna see it as popular.

00:06:46: so diabetes is losing everywhere because there's a chronic disease they don't want to fund.

00:06:51: and then decimated the Centers for Disease Control where everybody knows what their role is.

00:06:57: So whats gonna happen about knowing whats happening in terms of number people with diabetes etc.

00:07:03: And the last proposal now that looks like it's going to happen and administration can do on their own, which really affects people with diabetes as well is in the past.

00:07:15: today still researchers evaluated by your peers a peer review system.

00:07:22: The funding put at a pay line above grants will get funded From October, they're changing that.

00:07:29: So it's no longer can the Institute set the pay line.

00:07:32: a political appointee who might have nothing to do with ELF will decide which grants get funded?

00:07:38: And that is really quite disturbing.

00:07:41: Yeah I think its very disturbing.

00:07:43: Now there are hope That the administration would come around and companies and individuals would reach out their representatives in United States.

00:07:57: Everybody understands that Secretary Kennedy's emphasis on chronic disease makes sense to a lot of people.

00:08:07: We need to find better treatments for chronic diseases, the cause most our costs in healthcare system and way forward.

00:08:18: reduce health care expenses at federal level is come up with better treatment.

00:08:24: I do think research can advance.

00:08:28: And, you know the administration has been modestly responsive to concerns raised by constituents particularly constituents that are aligned in other areas of their interests and I do think we have many powerful forces in the diabetes space that uh, Have a voice Uh In Washington DC and we just need to make sure that they make their voices heard.

00:08:58: Do you feel concerned?

00:09:00: Particularly given what's going on at the moment.

00:09:03: The states the assassination of Charlie Kirk words that we've heard from the president and all sorts of other people about going after anybody who criticizes the administration.

00:09:20: Do you feel a sense of concern yourselves, about standing up being counted?

00:09:29: Yes I do Vivienne feel asense of concerned but i think one's got to go beyond oneself.

00:09:36: Over the decades, nothing changes until people stand up.

00:09:40: And I feel that we as a group—the four editors decided —that it didn't matter what the risk was... ...it was time to stand-up and point this

00:09:49: out.".

00:09:50: The hope still is that people will take the message we put in that editorial….

00:09:55: …and use it as means to think about these issues, educate themselves some more,….

00:10:00: …and then potentially also be asked by the administration like all of us!

00:10:04: to go ahead and try make some changes.

00:10:07: So we need more of a Spartacus moment, where we all stand up... ...and say this shall not pass?

00:10:13: And I think particularly those who are advanced in our careers In some ways have less to lose.

00:10:22: If the government were come after me and ensure that i never was funded again

00:10:29: You'd go fishing!

00:10:30: I literally would go fishing.

00:10:33: So it makes it easier for me to stand up and i'm mostly standing up from my younger colleagues in my patients, you know who don't have a voice?

00:10:42: And we're extremely grateful that You gave us some voice here at the ASD meeting.

00:10:49: Well also towards the end of my career... ...and just think its important as exactly because little to lose compared to our junior colleagues that we have to make a stand on these things.

00:11:08: Because, to be silent is to be

00:11:10: complicit.".

00:11:12: And I would add too that you know... We talk about where at the end of our career or it's out patience?

00:11:18: It's not just our patients but everyone!

00:11:20: It doesn't mean diabetes has got to be our sole focus.

00:11:23: When we wrote this editorial, we wrote it about diabetes because we edit a Diabetes Journal.

00:11:29: But you can replace the word diabetes with another word that starts with D and that's disease – It applies to everything!

00:11:36: And I think that is why we have got to think of this as an US problem….

00:11:40: …and frequently what happens in the US impacts the rest of the world.

00:11:44: So again... ...this sort-of behaviour—in terms of how healthcare will not be good for everyone else?

00:11:51: Well, thank you both very much for being courageous and doing the right thing.

00:11:57: Doing that really matters!

00:12:01: Thank You!

00:12:20: You can find plenty more information at EASD.org.