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A conversation with Samuel Dagogo-Jack, MD
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In this issue, Endocrine Today talks with Samuel Dagogo-Jack, MD, MB, BS, MSc, FRCP, FACP, FACE, Editorial Board member and the division chief of endocrinology, diabetes and metabolism; director of the endocrinology fellowship training program; and director of the general clinical research center at the University of Tennessee Health Science Center, Memphis. He also is the 2015 president for medicine and science for the American Diabetes Association Board of Directors. A husband and a father of four, Dagogo-Jack is a global citizen who has studied, practiced and taught medicine on four continents and now calls the United States his home.
Was there a defining moment that led you to your field?
Dr. Dagogo-Jack: There was no single defining moment for me. Along the way, I made a decision between internal medicine vs. the surgical specialties — to be a “thinking” physician. After residency training, the decision to seek subspecialty training was not difficult because it was something I’ve always wanted to do. The big question was whether to pursue a cognitive specialty or an operative procedure-oriented specialty, like gastroenterology or cardiology. Again, it was a natural fit for me to choose a cognitive specialty like endocrinology. That choice was facilitated by some of the positive role models I encountered at earlier stages in my training.
Samuel Dagogo-Jack
One important point is that throughout the process, income and revenue composition were never even remotely factors in my choice. This is quite a contrast to what I see among many recent graduates who consult websites to estimate how much money they can expect to make in different specialties. When I was in school, how much we would earn was the least consideration for students when selecting which specialty to pursue.
What area of research in endocrinology most interests you right now and why?
Dr. Dagogo-Jack: My current research focuses on the pathobiology of prediabetes. The 2014 CDC report says we now have 29.1 million Americans with diabetes and an estimated 86.1 million with prediabetes. Worldwide, more than 400 million people have prediabetes. Type 2 diabetes is the form of the disease that contributes to the epidemic, and that type does not suddenly happen to people — they inch their way there. Prediabetes represents the halfway point between normal and full-blown diabetes, so focusing on that condition makes a lot of sense. My research is in uncovering some of the predictors, risk factors and mechanisms that shift people who are born with normal glucose to prediabetes and then to diabetes. Understanding that early proximal stage of transition in early glucose abnormality is going to be critical, so that’s where I’m focused right now.
What advice would you offer a student in medical school today?
Dr. Dagogo-Jack: Be the best doctor you can possibly be. Study hard, be practical and love the clinics so much that you don’t limit yourself to scheduled rotations and assigned duties. To study medicine without books is to go to sea without a compass, but to study medicine with books alone is not to go to sea at all, to paraphrase a wise person. Textbooks serve to interpret what we see on the wards and the clinics.
Find a role model, someone you respect in the profession and have good reasons for placing in high regard. View that person as an archetype for what you can imagine your future life becoming. At every stage of my career, I have had role models. Don’t choose just one mentor because you are likely to outgrow earlier mentors, whose skills may no longer be applicable to your next challenge.
Follow your interests, and look for the best natural fit between your interests, abilities and available options. We have a wealth of specialties, but the more choices you have, the more difficult the decision, so think carefully. I’ve seen people superficially select a specialty thinking they are going to make a ton of money and then become miserable because they don’t enjoy their choice.
Have you ever been fortunate enough to witness or to have been part of medical history in the making?
Dr. Dagogo-Jack: I still consider myself mid-career and relatively young, so I would say I’m still on the journey to discovery. At the top of the interim histories that I have been part of would be the Diabetes Prevention Program (DPP) study, which demonstrated that high-risk people with prediabetes can avoid progression to full-blown diabetes with relatively simple lifestyle adjustments. That approach was more effective than giving them a pill. Other areas of medicine are now translating the DPP findings to make a dent in the diabetic epidemic we are seeing.
I am also involved in the Epidemiology of Diabetes Interventions and Complications extension of the Diabetes Control and Complications Trial, which discovered a phenomenon known as metabolic memory, or legacy effect, in which individuals who had good glucose control with their diabetes many years ago continue to manifest a benefit in terms of prevention of complications years later, even if their control may have deteriorated somewhat. The prior period of excellent glucose control may have locked in benefit that registered as a memory in their metabolism. That concept has since been corroborated by other work done in Europe. It’s something I am quite proud of and sends a very optimistic message to people that if they work hard on their diabetes control, they’re likely to reap benefits far outlasting the period of their hardest work.
What do you think will have the greatest influence on your field in the next 10 years?
Dr. Dagogo-Jack: Momentous discoveries are not planned — they happen through serendipity. As a diabetes researcher, my greatest wish is we will find a cure for diabetes, one we can administer that will eliminate established disease without any additional need for drug therapy.
More likely, I see a potential breakthrough in terms of a marriage of the “-omics” sciences with behavioral science to uncover genomic, proteomic, metabolomics and environmental predictors of why some people with chronic disease have difficultly adhering to recommended regimens that they themselves know to be good for them. What is it that predicts adherence? Medications work only when they are taken.
The noncompliance rate for chronic diseases that are not accompanied by serious pain may be as high as 50%, which is staggering. People don’t intend to harm themselves. There is an opportunity here, and I am optimistic that innovative thinkers will figure out a way to apply cutting-edge methodologies in the molecular, genomic sciences to what appears to be more of a social science problem. – by Allegra Tiver