a doctor has a dream

by Reza Corinne Clifton

Dr. Padma Balasubramanian has a lot on her mind. There are statistics she compiled pointing to more than 50 million Americans living day-today without health insurance. There is the Harvard University study she read about how an absence of insurance affects life expectancy. Oh, and there is the fact that her office recently relocated from Attleboro, Massachusetts to Foxboro.

Some doctors might be worried that a move could cause a drop in their patient load. But as an endocrinology and diabetes specialist, Dr. Balasubramanian probably has little to worry about. That is because as the doctor herself is aware, more than 60% of Americans are overweight or obese, a significant risk-factor for diabetes -- and a host of other heart, joint, and breathing problems.

But Dr. Balasubramanian is not sitting in a back room comparing negative statistics with personal earnings. On the contrary; she is on the front lines, from the inner city of Dorchester, Massachusetts to her hometown in Southern India, talking to youth and adults about the benefits and habits of a healthy lifestyle – and the dangers of choosing not to pursue one.

In the midst of packing boxes and prepping patients for her office reopening, the specialist made time to talk to me about human rights, patient advocacy, and why she does not like the Atkins Diet.

About Padma Balasubramanian: Dr. Balasubramanian was born and grew up in the city of Hyderabad in the southern Indian state of Andhra Pradesh. She comes from what she calls "a middle-class family," where her grandfather and uncle were judges, her father worked for the government, and her mother was a college educator.

She attended college and medical school in India, and, before moving to the U.S., lived in Britain doing three years of medical residency there. She moved to the U.S. as a 25 year old – with no problem adjusting "at all" – to do an internal medicine residency in Worcester. She later did a fellowship in endocrinology and diabetes at Brown University in Providence.

Patient Advocacy and Human Rights: Ask Dr. Balasubramanian what kind of medical advice she might give to someone without health insurance, and she clearly struggles with the answer. Why?

The doctor is very insistent about the role of regular check-ups and screenings in the battle for individuals to stay healthy, but she is aware that office visits and referrals can seem like – or are, depending on the political climate – insurmountable barriers to the uninsured and, therefore, a barrier to optimal care and health. In fact, that is why the question of advising the uninsured pains her so dearly. "Ultimately," says Dr. Balasubramanian, "we want . . . medicine that helps people live long lives and reach their full potential."

And to her, it is not a question of only some getting those benefits. "Being a physician," says Dr. Balasubramanian, is "doing good for people and it can be looked at from a human rights perspective." Citing Dr. King as an inspiration for her views, she reflects, "I believe health care should be a human right."

As part of this belief, Dr. Balasubramanian believes in sharing tips to a healthy life; she frequently presents on diabetes. She speaks to patients, support groups, medical colleagues, community and labor groups, and to youth – especially in Attleboro, Dorchester, Boston and other Massachusetts communities. Her outreach is international in scope as well, though.

She provides voluntary care and advice on diabetes annually with a program in her hometown of Hyderabad, and she is part of an organization called The Medico Friend’s Circle, which is dedicated to addressing and improving healthcare in India.

Calling Out to Youth,Women, and People of Color: Given the doctor’s specialty with diabetes and who historically suffers from it, much of her local volunteer work, compiled national data, and presentation materials pertain to or are designed for communities of color. "About 8% of the U.S. population now has diabetes," she explains, but African-Americans, she contrasts, are at a rate of "13%." But she is also quite concerned with women and children in the U.S., especially those who are overweight and obese; ethnic minorities; and those living in urban areas and inner cities.

Women of all ethnicities, according to an article she showed me from the Association of Black Nursing Faculty, are more affected by obesity than men. But especially alarming is the disturbing rise of diabetes in youth, according to data – and according to what the physician herself has observed. "More and more young people," says Dr. Balasubramanian, "with not Type 1 but Type 2 diabetes" are becoming patients of hers. "Obesity is a major risk factor," says the doctor, "and it is to do with lifestyle."

It was also clear at a community presentation she gave recently to a group of Latino teen peer leaders in Dorchester, Massachusetts. They themselves, she says, "discussed [obesity] in detail . . . as an epidemic in the U.S., especially for young people" and people of color.

Health for Life: As a careprovider to her patients and an informed orator to her audiences, Dr. Balasubramanian is fluent in the language of solutions, strategies, prevention and wellness. And starting with youth is a priority, insists the specialist.

"We used to think of diabetes as a disease of the middle aged," says Dr. Balasubramanian, but we need to start addressing healthy lifestyle choices earlier. And the message, says the physician, needs to come from "governments, physicians, and communities."

She also says it has to be much bigger than pharmaceuticals. The doctor openly recognizes the benefits of medications, saying individual problems have to "be treated," but she also cites compelling long-range research showing the benefits of exercise and a healthy, moderate diet. Both "pre-diabetic" and "healthy" patients, studies show, prevented the development or progression of diabetes, heart disease, and stroke through "weight loss, diet change, and exercise." Also proven was that these lifestyle changes and "interventions" worked better than medication and mere advice.

But she also recommends keeping regular appointments with general physicians, and seeing a nutritionist for in-depth dietary questions. For the morbidly obese, it is important to see a cardiologist before beginning an exercise routine, since you could be at-risk for silent heart disease. For all, she says, it is about age-appropriate, risk-centered screenings.

"Hitting age 45 is considered a risk for diabetes," continues the doctor, "so by the time a patient hits 45, we automatically start screening." And so is your family’s medical history, insists the good doctor. "A person who has a family member," she explains, "Native Americans, African- Americans, Latinos, those with a firstdegree relative, those who were born ten pounds and heavier – these people are all at risk."

At-risk or ready to attack – your choice.

Dr. Padma Balasubramanian can be reached at her new office at 70 Walnut Street in Foxboro, Massachusetts. For more on preventing or treating diabetes, visit www.diabetes.org to see information provided by the American Diabetes Association.