Dr. Howard Wolpert, a leader in diabetes care, left the Joslin Diabetes Center in Boston to work in industry. But his career, and his life, eventually came full circle. This profile is part of an occasional series at diaTribe to showcase people and issues who have devoted their lives to the field of diabetes research and care.
It is not unusual for an endocrinologist to leave the clinic and accept a job in industry, where the pay is better and the demands are fewer. What’s less common is for that same endocrinologist to then return to a clinic to work directly with patients – and not just any clinic, but to an under-resourced city medical center that serves at-risk populations.
But those were the surprising career moves of Dr. Howard Wolpert. For almost 30 years, he worked at the Joslin Diabetes Center in Boston, where he spearheaded the use of technology to improve outcomes and where his gentle touch with young adults was a model in how to motivate and support patients.
Then in 2016, he left Joslin and joined the Eli Lilly Innovation Center in Cambridge, with the goal of helping Lilly develop and commercialize diabetes medical devices. But he left that position after five years to join the adult diabetes program at Boston Medical Center (BMC), the principal teaching affiliate of the Boston University School of Medicine. At BMC, two-thirds of the clinic’s patients are on public insurance and a large percentage are Black or Latino.
The BMC, in the city’s South End, is less than three miles from the Joslin Clinic, but it might as well be on the opposite end of the planet. The Joslin Clinic was founded by Elliott Joslin, America’s preeminent diabetologist of the 20th century, and it remains one of the world’s most prestigious diabetes centers, attracting self-referred patients from all over the country.
BMC describes itself as “a safety-net hospital” for Eastern Massachusetts. Its lobby includes signs written in multiple languages, reflecting the diverse patient population. One of Wolpert’s patients is a driver for Amazon Prime. Another is an undocumented immigrant who works as a dishwasher. Another is a refugee from Haiti.
“These are not Joslin patients,” Wolpert says from his spartan office. “But they want to do better.” If Wolpert’s career has taken some unexpected turns, it is part of a globe-girdling life journey that has had some bold leaps of faith.
Raised in South Africa
He was born in 1958 in Durban, South Africa, a large, bustling coastal city. South Africa had adopted apartheid in 1948, so Howard grew up in a segregated country where populations were classified by race and where non-white citizens were denied basic human rights. He had little engagement with Blacks as friends or peers, and like most white families, the Wolperts had Black servants.
“Racism was very stark in Durban and all of South Africa,” he says. “I was aware of this caste system. There was a servant class, and they were condemned to their position in life.”
Howard learned about apartheid’s cruelty from his father, Lionel, a physician who instilled in Howard a strong social and political consciousness. As Howard recalls, “He would tell me, ‘Whatever a person’s status is, you shouldn’t talk down to them. But by the same token, you should not talk up to them.”
The Wolperts’ belief that all people should be treated with dignity reflected his family’s own insecurity as Jews. “We were sensitized about being discriminated against,” Wolpert says, “and we understood prejudice.”
Indeed, Howard’s family lived in the shadow of the Holocaust – Howard’s maternal grandmother had immigrated to South Africa from Lithuania in the 1920s, leaving behind her parents, brother, and sister, all of whom were murdered by the Nazis. In high school, Howard wrote a paper on how the weakness of the Weimar Republic created an opening for Hitler.
“The fragility of civilizations in society was something I was obsessed with as a kid,” he says.
Howard’s father died when Howard was 19, so he didn’t see his son follow his medical footsteps. Howard attended medical school at the University of Witwatersrand in Johannesburg, and there he developed his interest in diabetes, which appealed to both his analytical and humanistic impulses.
“A lot of diabetes is applied physiology, applied pharmacology,” he says. “It’s nutrition and insulin action . . . The mechanistic aspect of diabetes appealed to me.”
But diabetes, according to Wolpert, is about much more than diagnosing a problem, solving it, and moving on. It’s about engaging with people, understanding their world, and serving as coach and mentor. The daily management of diabetes is constantly fine-tuned, which can intensify the interaction between clinician and patient.
Taking care of diabetes, Wolpert says, “is more time consuming than just writing a prescription and telling people what to do, but what’s the satisfaction of that?”
He graduated medical school in 1984 and then came to a crossroads. South Africa had mandatory military service, but the military was not simply to protect the country against foreign threats. “Essentially, the military was an instrument of oppression and control” of other South Africans, Wolpert says. “I decided I wasn’t going to be part of that.”
So he left his home country, leaving behind his mother and two sisters, and he departed believing he would never be allowed to return. Conceivably, he would never see his family again. Howard Wolpert, in his words, was now a “draft dodger.”
His new home: America.
A New Era in Diabetes
Immigrating to a new country isn’t easy for anyone, but as Wolpert notes, he was not exactly unskilled. He passed his board exams in the United States, was accepted into a residency program at Deaconess Hospital Boston, and joined Joslin as a Fellow in 1987. By the early 1990s, he was part of Joslin’s physician staff, and the timing was perfect.
A departing Joslin physician allowed Wolpert to inherit a large cohort of older teens and young adults with type 1. They were ready to be more engaged with their diabetes – at the very moment when diabetes care itself was undergoing significant change. (Wolpert also saw many people with type 2.) In 1993, the landmark Diabetes Control and Complications Trial was completed, with the results showing that improved glucose management can reduce the risk of eye and kidney disease. The outcome settled a long-standing debate about the benefits of intensive therapy, nudged insurers to pay for existing and emerging technologies, and gave momentum to far-sighted clinicians who wanted to aggressively promote these therapies.
Wolpert was among those progressive clinicians; he embraced insulin pumps and then later continuous glucose monitors, connected insulin pens, mobile apps, hybrid-closed-loop systems, and other devices.
While Wolpert advocated intensive therapy for tight control, he also preached empathy – influenced, no doubt, by the fact his wife, Myra, a researcher whom he met at Joslin, has type 1 diabetes as well.
Wolpert feared that people who fell short of their blood sugar goals considered themselves failures – a message that some physicians seemed eager to convey. But Wolpert’s message was different: When you have a good day, you take credit for it. When you have a bad day, you blame the disease and move on.
For a man keenly aware of the “fragility of civilizations,” Wolpert was determined not to allow one bad day to destroy the world of his patients.
Opening New Doors
Wolpert’s separation from his family did not last long.
His two sisters followed him to America in the 1980s. Then in 1990, Nelson Mandela was released from prison in South Africa, marking the beginning of the end of apartheid. This allowed Wolpert to return to his home country, which he did in 1992, and he has made a couple trips since. His mother remained in South Africa until 1999 and then moved to America; she now lives in Pittsburgh.
“I just count how fortunate I’ve been,” Wolpert says, his voice still tinged with a South African accent. “I wonder what my life circumstances would have been if I had been born Black or a woman in 1958 in Durban, South Africa.”
In 2016, he embarked on what he calls his second immigration experience – his move to the new Eli Lilly Innovation Center in Cambridge. Joslin had experienced turnover in its leadership, and Wolpert thought he could make a bigger impact in diabetes if he worked on the development of new devices and technologies. But the Center never really took off. Lilly is a pharmaceutical giant, and the process of developing new drugs is very different from devices. The leader of the Center departed for another company, and according to Wolpert, the clinical trials that he was involved in could not be published. Whereas publishing is considered essential in academic medicine – researchers want to share information – industry is more focused on retaining proprietary information for competitive advantage.
Wolpert left Lilly in 2021.
He could have stayed in industry, but he returned to clinical care by joining BMC.
Why return to any clinic? “Because I was missing the actual interaction with patients,” Wolpert says. He chose BMC in part because the head of its diabetes division had been one of his Fellows when he was at Joslin. But he also wanted to work where there was the greatest need – the BMC network has about 50,000 people with diabetes, one-quarter of whom have an A1C of more than 9 percent.
“What happens at a busy public hospital like this is that people are so focused on just getting through the day, it’s hard to step back and say, ‘What are the needs and how do we address them,’” Wolpert says.
One challenge is how to integrate reams of blood-sugar data – from connected pens, CGMs, insulin pumps, and glucose meters – into actual care. The numbers don’t mean much if neither the clinician nor the patients know what to do with them. Better tools are needed, Wolpert says, to integrate the data into the clinical workflow and then to translate the data into guidance.
It is not simply a resource issue – Wolpert says that 80 percent of people with type 1 at BMC, with the support of Medicaid, use a CGM, but that has not translated into improved outcomes. “It’s not just about throwing education at patients,” he says. “It needs to be individualized so that the guidance is meaningful.”
There are other obstacles, including at BMC itself. “When I had a new type 1 patient at Joslin, we had all these programs to plug that person into,” Wolpert says, including those programs to educate people on ketones, sick day protocols, and glucagon as well as nutrition and insulin. BMC, to be sure, is not without its own resources. It has two diabetes educators and novel programs related to its pharmacy and to a therapeutic food pantry – doctors write “prescriptions” for supplemental foods to promote health. But BMC still lacks the programmatic depth that Joslin had.
Cultural hurdles also complicate matters. According to Wolpert, some Haitian patients believe that insulin compromises libido, while some Hispanic patients associate insulin with diabetes-related complications – they saw their relatives begin to take insulin right before they had a limb amputated or a kidney fail.
Nutrition can also be problematic. High-glycemic fruits are extremely popular in some immigrant communities but pose obvious challenges for anyone with diabetes. Food labels are also confusing to anyone who has not been taught how to interpret them, let alone anyone for whom English is not their first language.
Wolpert fears that some patients could adopt a similar mindset to Black South Africans during apartheid – a “sense of fatalism because they can’t change their destiny.”
But Black South Africans fought to change their destiny, and Wolpert remains optimistic about people who receive care at BMC and elsewhere, regardless of socioeconomic status.
Many have smartphones, which creates new opportunities for virtual care and for coaching and engagement. They also have agency. “I’m not saying there aren’t challenges,” Wolpert says, “but the needle can be moved.”
It is not lost on Wolpert that he is now devoting his professional life to the very people who in his youth were relegated to second-class citizenship.
For some, he said, being raised under apartheid, “could make them callously indifferent, because they become inured to it, and their privilege became a sense of entitlement. But I see myself as privileged as far as the opportunities that I’ve had, and I feel that obligation today.”