Test Tubes to Fast Foods: Discussing Metabolism with Dr. Ethan Weiss — The 5Q

In the 5Q, Tincture sits down with leaders to discuss their day to day work and share their perspectives on healthcare, medicine, and progress.

Dr. Ethan Weiss is a physician-scientist and associate professor at UCSF. Dr. Weiss specializes in preventive cardiology and has research and clinical interests in obesity and metabolism, lipid metabolism, and assessment of cardiovascular disease risk.

Tincture: You work at the intersection of cardiology, preventive medicine, genetics…anything else? Can you explain your research focus in a sentence or two? Zooming out, what is the problem you are trying to solve?

Dr. Ethan Weiss: Our research aims to understand complex physiology relating to metabolism (insulin and glucose metabolism), type 2 diabetes, and obesity. We are particularly focused on the role of growth hormone (GH) signaling on metabolism and risk of metabolic diseases. With the epidemic of obesity and type 2 diabetes exploding, we hope to offer greater insights into the underlying causes and identify potential treatment targets.

What motivated you to embark on your medical career? Has that changed since you began practicing medicine, and if so, how and why?

I grew up with a cardiologist as a Dad, but went to college intending to study music. I eventually gravitated toward science and medicine as a career where I could combine service and the intellectual challenges of science and medicine.

When I went to medical school, I knew very little science. I struggled mightily with medical school the first year and as such went to work in a lab to get my hands dirty. I fell in love with science very quickly and have had a career balancing science and medicine ever since.

Cardiac Disease is the number one cause of death in the United States. Will we ever be able to knock this further down the list? What are the different components of a successful national strategy to decrease morbidity and mortality?

Tough question. We need to balance short-term and long-term goals, and we need to balance practical with more theoretical approaches. I am a fundamental believer in the power of basic science research and think it is a foundation for understanding and solving major medical problems. Yet we also need to focus on health and prevention and strategies to identify ways to reduce costs and to become more efficient with disease prevention and care.

On one hand, we’re advancing the medical science behind treating chronic conditions; we’re gaining an understand of how specific genes drive metabolic disease in the name of “personalized medicine.” On the other hand, clinicians are advocating for more “generic” low-tech care — fewer complex carbohydrates, better sleep and exercise, intermittent fasting — to improve our health and longevity.

As someone with “one hand on a microscope and another on a stethoscope” — can you comment on these contrasting approaches to the same problem?

That describes my philosophy in a nutshell. As I mentioned above, I truly value fundamental basic science research. The ways we have taken HIV/AIDS from being a death sentence to a manageable chronic disease in such a short period of time is a testament to the power of our science. We are making amazing progress in understanding and treating cancer and hopefully will do similar things for most cancers soon.

Yet, many of these investments will not pay off for 20, 30 years or longer, or they may never pay off. There is great promise with new technologies like immune-oncology or CRISPR/Cas9. But in the meantime, we have a growing, aging population and we need to find solutions to many of our most challenging chronic diseases sooner. Our system incentivizes big scientific discoveries but few of these are now aimed at the challenges of common, complex, and chronic diseases like type 2 diabetes, obesity, hypertension.

We must learn how to conduct rigorous and meaningful studies to evaluate novel nutritional or exercise interventions. We will almost certainly need to let go of the security blanket of the large prospective randomized controlled clinical trial and find new ways to test and validate these interventions. But we need to validate them and simply recommending things based on expert opinion is not acceptable (to me).

Despite progress in science, health policy, mobile technology, and other areas, we are still a “Fast Food Nation.” This doesn’t look like it will change anytime soon: One in three US children is overweight or obese. One in three of us eats fast food every day. This adds a seemingly Sisyphean nuance to your work — Is this an issue that keeps you up at night?

I hope it does change! But this does not keep me up at all. It is a huge challenge and I love puzzles. We just need to figure it out and we need to take a thoughtful and humble approach and let go of dogma. There are examples of amazing success stories here and I am very optimistic.

Heck, when I was a kid, even with a cardiologist father, our big dinners out were at McDonald’s or Burger King. My kids think those places are poison. My kids eat better than I ate until about 15 years ago. The challenge is that some of the things they like and some of the things that are the healthiest for them are also the most expensive. But again, the education part has happened. We now just need to find the solutions.

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