On The Waterfront: Highlights of ENDO 2015

From thyroid cancer-sniffing dogs to honoring the memory of an endocrinology giant, ENDO 2015 in San Diego gave attendees the chance to bask in the sun as well as in the glow of the best and brightest from the field of endocrinology.

For five sunny days in San Diego, California, the Endocrine Society held its 97th annual meeting, once again bringing the world’s endocrinologists together to share their ideas. The signs of ENDO 2015 were everywhere: Lampposts in San Diego’s historic Gaslamp District were adorned with banners announcing the meeting. People with lanyards draped around their necks and black ENDO bags on their shoulders smiled at one another as they walked among the yachts and along the harbor.

Downtown San Diego was alive with thousands of attendees — 8,511 in total — all there to hear about the latest developments, the groundbreaking research, or even advice on setting up their own practices and labs.

But it was inside the soaring, 200,000-square-foot Convention Center where the real party happened, where clinicians and researchers presented 2,428 abstracts, held sessions and press conferences and workshops, and discussed the latest initiatives, advocacy, and public policy.

Diabetes and the Affordable Care Act

The first day of ENDO 2015 featured a session titled “Implementation of the ACA and the Future of Diabetes Care,” moderated by Robert Vigersky, MD, director of the Diabetes Institute at Walter Reed Medical Center in Bethesda, Md., and past president of the Endocrine Society. The session was an update to the policy summit the Endocrine Society held on September 12 of last year in Washington, D.C., which explored the obstacles and challenges of the patient/provider/payer relationship now that the Affordable Care Act (ACA) is in full swing.

Diabetes is a growing epidemic in the U.S., with more and more people being diagnosed every year, which means ballooning costs to treat this chronic disease that often presents a number of challenges to patients, physicians, and payers alike. And now that the ACA has been introduced, this shift in healthcare policy is bound to have an impact on diabetes care, so it’s essential to proceed carefully to benefit everyone involved.

Spending to treat diabetes has increased 41% over the past five years, according to Daniel Einhorn, MD, of the University of California San Diego, who spoke first and touched on the clinical and economic burdens of diabetes in the U.S. That increased spending, coupled with the ongoing shortage of endocrinologists in this country, is causing burnout. Diabetes is a complex disease and often frustrating to treat, Einhorn says, so more and more physicians are simply bowing out of treating it. New therapies are not covered by payors, so endocrinologists are not interested in learning about them; doctors have to “write a small essay” every time they order test strips; and physicians treating complex diabetes often end up in the red. “Those who provide care to patients with diabetes are in a losing proposition,” Einhorn says.

Anne Peters, MD, of the University of Southern California, treats diabetes in both the rich and poor areas of Los Angeles, says that the key to treating diabetes is prevention, because “there will be way too many diabetic patients for us all to treat.” Diabetes rates are twice as high in the poor areas of Los Angeles, so researchers and other parties have started community diabetes initiatives there. But these are complicated ecosystems that must be changed carefully. For example, there are many fast food restaurants in poor areas, and fast food restaurants are often major employers of the people who live there, so just getting rid of fast food restaurants is out of the question. One of the first solutions was farmers markets with fresh fruits and vegetables, with these markets accepting food stamps and vouchers from endocrinologists’ ofices.

Another complication is that the people in these areas are often wary, because researchers typically just come in, gather data, and leave. The University of California Los Angeles had the idea to remake corner stores into nicer stores filled with fresh fruits and vegetables, but UCLA left, and these stores became the targets of crime because they were so much nicer than the others. According to Peters, it’s important then to build trust. “You can’t do this for a community,” she says. “You have to do this with a community.”

Right now, there is what Vigersky calls a “severe imbalance” in the supply and demand for endocrinologists, which is further compounded by the tension between guideline-driven care and reimbursement. And that gap could continue to grow as diabetes prevalence increases. He pointed to several solutions to narrow this gap, such as shared decision making in care management and fee-for-service and patient management fee payment reform models, as well as forgiving educational loans for new medical professionals, increasing endocrine fellowship training, and educating primary care physicians on the standards of diabetes care.

Chip Ridgway’s Life and Legacy


The morning of the second day of ENDO 2015, hundreds gathered to pay tribute to E. Chester “Chip” Ridgway, MD, MACP, of the University of Colorado, a former Endocrine Society president and a titan in the world of endocrinology, who passed away last year. David S. Cooper, MD, of the Johns Hopkins University School of Medicine, and moderator of the Chip Ridgway Memorial Symposium, noted that “thousands of endocrine fellows have benefited from Ridgway’s programs.” He showed slides of photographs through the years, of smiling fellows standing behind Ridgway, many of whom have gone on to win endocrinology awards and hold prestigious titles and positions, even president of the Endocrine Society, thanks to Ridgway’s guidance.

 

Paul Ladenson, MD, of Johns Hopkins Univeristy; Margaret Shupnik, PhD, of the University of Virginia; and Bryan R. Haugen, of the University of Colorado, all talked about Ridgway’s influence on their work and careers in medicine, walking the audience through the work they’ve done under Ridgway’s leadership, from studying the cardiac effects of thyroid hormone to thyroid-specific expression and regulation of TSH. (Ridgway’s Colorado license plate on his red Jeep read simply “TSH”.) They talked about missteps and how Ridgway picked them up and showed them a better or another way to work through the problem, or how he showed them simply another way to reach an answer. The symposium, according to Haugen, was about “remembering the work [Ridgway] brought to the field” and the effects he had on the speakers, the audience, and future generations of endocrinologists.

Dog Days of Thyroid Research

Ridgway was a pioneer in thyroid work, and his influence still seems to be reaching researchers and physicians today. Several groundbreaking thyroid studies were presented at ENDO 2015. One that’s already made headlines around the world is about Frankie, the male German Shepherd mix who can detect thyroid cancer in urine samples.

Donald Bodenner, MD, PhD, of the University of Arkansas for Medical Sciences in Little Rock, and his colleagues trained Frankie to recognize the smell of cancer in thyroid tissues obtained from multiple patients. They then had 34 patients provide a urine sample to the university thyroid clinic before having biopsies of suspicious thyroid nodules and surgery. Of these 34 patients, 15 were diagnosed with thyroid cancer and 19 were diagnosed with benign thyroid disease. Frankie sniffed each sample, one at a time, alerting his handler to cancer in a sample by lying down and turning away when he detected a benign sample. Frankie’s alerts turned out to match the final surgical pathology diagnosis in 30 out of 34 of the study samples. The dog correctly identified thyroid cancer 87% of the time, and he correctly detected the benign samples almost 90% of the time.

Bodenner sees this as an inexpensive and noninvasive way to detect thyroid cancer, and that this technique could be employed in underserved areas and third-world countries. His program will soon be collaborating with Auburn University College of Veterinary Medicine in Alabama to train bomb-sniffing dogs coming back from Iraq and Afghanistan. He said these dogs make the perfect candidates because they’ve already been trained to detect scents and their handlers “don’t know what to do with them.” Jason Wexler, MD, of MedStar Washington Hospital Center in Washington, D.C., says that using dogs to detect thyroid cancer in urine samples “could have widespread appeal,” since thyroid cancer tests are invasive, painful, and very expensive.

Looking Ahead

ENDO 2015 was a short nine months after last year’s meeting in Chicago, but you’ll have a little more time to catch your breath this time around. There’s a full 13 months between ENDO 2015 and next year’s meeting in Boston, so save the date now: April 1 – 4. Visit endo2016. org for more information.
— Bagley is the associate editor of Endocrine News. He wrote about
fracking and endocrine-disrupting chemicals in the April issue.

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