For nearly three decades, Dr. Howard Wolpert has been the man behind technology and innovation at Boston's legendary Joslin Diabetes Center.
For those who may not be as hip to his name, Dr. Wolpert built the insulin pump and technology program at Joslin from the ground up in the 90s, and through the years he’s been instrumental in clinical work to help get continuous glucose monitors covered by insurance, as well as developing innovations such as , a new data platform to track hypoglycemia trends. In the past few years, he’s headed up the new (JITT) that’s been connecting the dots between clinical solutions and medtech companies.
A potentially game-changing new chapter begins now, as Dr. Wolpert is leaving Joslin for a new role: VP of Medical Innovation at the new . Launched in May 2015, the center will focus on drug delivery and device innovations, including what the Big Insulin maker has in the works on smart insulin pens, as well as other advanced wireless tools.
We had the chance to talk to Dr. Wolpert by phone recently about his time at Joslin and this exciting new move, and here's what he has to say...
A Chat with Dr. Howard Wolpert
DM) Can you kindly start by stepping back in time to tell us how you came to diabetes care and to Joslin in the first place?
HW) I started at Joslin as a fellow 29 years ago, on July 1, 1987. To put that into perspective, I really came of age professionally at just the time ) was happening and published in 1993. The whole shift in diabetes management and intensive therapy was happening. At that same time, I inherited this whole population of young adults who were coming of age. The future was becoming real, and they were becoming more engaged and receptive to intensifying their glucose control.
It was like we were actually coming out of the Dark Ages in diabetes. Glucose monitoring strips weren’t really covered until the DCCT results came out. Then you started seeing newer insulins in the 80s and 90s, and a lot was changing in diabetes.
What really drew me to diabetes originally was that I liked engaging with patients more as an equal, as a coach -- very different from the rest of medicine that’s very prescriptive.
How did you embrace technology in your practice?
It was really a combination of all these factors coming together at the same time for me -- the DCCT, young adults, and my view on being a coach for patients.
So... my whole clinical practice focused on technology and behavior change, which is a central part of all this. The key is how you engage people with their data and diabetes. Part of that is basically understanding what the individual barriers are, and giving patients realistic goals to feel confident and have self-efficacy around their diabetes.
It was an era of embracing all of this in my practice, first with pump therapy and then when CGM came along, and now with all the phone apps and smart technology we’re seeing. I’ve tried to leverage all of these new technologies in terms of optimizing control, and I’ve been fortunate to have been in an environment where there’s been an infrastructure to develop programs to leverage these tools.
Can you tell us about the Joslin Pump and Technology Program that you started?
Everything started in the 90s. Basically, there was a time post-DCCT when insurance coverage for pumps was starting to happen. Part of the focus was around formalizing the training and education for patients. For the manufacturers, a lot of that has to do with the button-pushing and settings, not on how you benefit using the technology and how patients start understanding their own physiology with this tech. It’s the same with CGM, which is another way of engaging people more with their own diabetes.
So I set up this program when we had early pumps and blinded CGM. We had education programs where people came in every day and downloaded their devices, so we could use that experience coupled with general diabetes health management to learn how this tech was being used. And that all set the stage for the JDRF trial that led to getting CGM insurance coverage.
The whole focus on the training programs is to make sure patients have some core foundation of key diabetes knowledge and understandings around nutrition. There’s also a risk of burnout, and there are a lot of key issues that people need to be familiar with in order to realize the full benefits of this technology. We try to ensure that everyone has access to that type of guidance.
We really have come a long way in the past 30 years, haven’t we?
It’s a phenomenon. The outlook of people with diabetes has been completely transformed. When I started out, people were coming in with seeing eye dogs, amputations, and all types of neuropathies. Really, when you look at things today, you don’t often see that. Now, many patients say they’re in better health than their non-diabetic contemporaries, because they’re watching their health so much more. People aren’t dying from diabetes like back then, they’re dying with diabetes.
What was it like working on HypoMap with Glooko and the ?
It was an experience in using platforms like a smartphone to develop diabetes management tools. There’s a much broader opportunity here, to develop these tools for people. The reality is that people live on their phones all the time now. The opportunity in giving them the tech tools to use for diabetes is immense. So, HypoMap and the were learning experiences for me. I learned that this tech is very intricate, and requires close interaction with engineers and involvements with patients, back and forth. I’ve enjoyed it, and that’s one of the reasons I have realized I’d be better in a company to do this on a much bigger scale. I’ve been trying to apply my insights of what I do in clinic to a digital tool.
What caught your eye about the Lilly Innovation Center?
In a sense, this is the next logical step. My wife said it’s the logical destination for my journey. I’ve always been interested in what tech can do for diabetes therapy. When you look at the potential of all these devices getting Bluetooth – pumps, meters, insulin pens, and CGMs – there's a tremendous opportunity to leverage all of those pieces with the fact that so many have smartphones in their pockets. So I feel that applying my expertise and approach, and building that into new management tools that everyone can access, is the right juncture and a great opportunity. When I took stock of all this, I thought it’s the right stage in my career for this change.
I’ve made an impact at a personal level for patients, with the systems I’ve set up at Joslin over the years, and now there’s an opportunity to do that on a bigger scale and broader stage at Lilly.
Can you tell us more about what your new job will entail?
There are a number of projects in the whole care space, and some additional things I’ll be working on and providing direction on. It crosses into hardware tools as well as software decision-support tools. There’s such broad potential, and the initial task will be to decide where to focus our energies. It’s great that Lilly is devoting a lot of resources to this, and it’s basically a startup environment. We’ll be drawing from smaller companies we can partner and collaborate with, and obviously with the resources of a big company like Lilly.
Ultimately, I think where we’re going is that there’s going to be a need for of systems, to bring digital health into care.
Lilly’s made news by partnering with Companion Medical on a smart insulin pen, which must be exciting to get involved with, no?
Yes, that’s a huge area of potential, in providing decision support and delivery. Just being able to integrate Bluetooth into insulin pens for better guidance on insulin dosing, and then using that with CGM and data platforms… will help patients realize a lot more benefit. We’re on the verge and it’s about to all explode, and I think once we reach a point where these digital health tools are prescribed for routine care, and patients get feedback on this from doctors, it’s going to snowball. This is a very exciting time.
When do you start?
I start in later July, after taking a vacation. And I don’t have to go very far. The new center is in , a big new biotech and medtech hub, located right next to MIT. I can get there by subway or walk, as it’s only two miles from Joslin, across the river in Cambridge.
What happens with the Joslin Innovation Institute that you’ve been leading?
The institute is being re-configured. I do have a colleague I’ve been working with and mentoring. She’ll be getting most of my patients. That is . She’ll be continuing the work and taking that on, and I do plan to continue collaborating pretty closely because as noted, I’m only going to be two miles away. We will be needing to iterate and work closely with patients in this whole innovation development process.
Do you think doctors and care teams are well-versed enough in technology?
Frankly, there aren’t many endocrinologists with that kind of interest or focus in this area. If you look at the type 1 space, we work with pediatric centers that recognize more than kids with diabetes need to be seen by specialists and they have more experience in this. But in the adult world, many with type 1s are taken care of by general internists who largely take care of type 2s, and for the most part don’t recognize that people with type 1 have extra specialized needs. And they aren’t as well-engaged in using these technologies. So it’s a huge problem. In our endocrine fellowship training (at Joslin), we get med students in their second year, after a year of general diabetes where they focus on technology. But most places don’t offer that kind of focus and guidance on technology.
What needs to change most in how doctors are trained?
Part of the problem with medical training, is that we learn to be physicians in a hospital environment. That’s where patients are more passive and we do things to them. Endocrine itself is a diagnostic field, where someone comes in, you diagnose them and tell them what to do. We have to get doctors to re-conceptualize their roles. If one’s to be effective in the diabetes space, think of yourself as a coach. It’s basically helping a person do what they need to develop the insights and mastery to manage their condition better. It’s a totally different role from typical medicine, and is about behavior change and engaging with someone. Too often, people just have the medical textbook thrown at them. We have to move away from the treat-to-fail mentality in diabetes care, and engage people more in whatever ways open up their interest in their diabetes.
Speaking of medical science, any impressions from the recent ADA conference
It really is exciting seeing everything that’s developing in this field. But the DiabetesMine D-Data forum and those types of events are really where it is, and it brings a much broader crowd than the professional meetings. At ADA at the professional meetings -- even though there are some patients and non-physicians -- it’s sort of exclusionary, frankly. The ADA has these professional groups, like nutrition and education, but there needs to be an additional one on tech-health. There is actually a real need for this, a bridge to the community and those developing this tech.
Congrats, Howard! We've thoroughly enjoyed working with you on the Joslin front, and are exited to see what comes next under your leadership at the new Lilly Innovation Center!