When Prof. Jesse Roth began research on diabetes half-a-century ago, the American endocrinologist never dreamed that by the time he was an octogenarian, it would become a worldwide epidemic, affecting 40 million people in the US and 400 million around the world. This epidemic has also spread to Third World countries whose residents have struggled with hunger for centuries but today are increasingly living with junk food and reduced physical activity.
A member of the scientific review board and then board of governors of the Weizmann Institute of Science, Roth was recently awarded an honorary doctorate from the Rehovot institution of higher learning. Two years ago, he was honored in the same way by the Ben-Gurion University of the Negev in Beersheba. “I have been to Israel countless times, the first time in 1967, around the time of the Six Day War.” he noted in a recent interview with The Jerusalem Post. He has received honorary doctorates from other prestigious institutions, including New York’s Yeshiva University, Uppsala University in Sweden and another the University of Rome.
The certificate presented to him at Weizmann recognized his “profound influence in the field of molecular medicine, most notably his groundbreaking work on insulin receptors, crucial to establishing scientific understanding of diabetes and other endocrine disorders; of his incalculable services to higher education in the US and beyond as an inspired teacher and mentor to generations of young researchers, including many from Israel; and of his vital concern for the advancement of scientific research in Israel, as demonstrated by his activity on the scientific and academic advisory committee of the Weizmann Institute of Science. He is best known for his research on cell-surface membrane receptors and other molecules of intercellular communication. His studies on the receptor for insulin and the receptor for adrenocorticotropin in the early 1970s became the model for many others that followed.”
Regarding his continuing research at his age, Roth noted that the US and Europe are moving away from age-based retirement, but institutions in Israel have been slower.
“The retirement age of 65 was codified by Prussian chancellor Otto van Bismarck in the 19th century, based on advice from his insurance actuaries. Academic institutions in Israel and around the world need to share experiences in doing away with agebased discrimination,” Roth said. “People live longer, are healthier and more physically and mentally fit than in previous generations. Many older professionals have a lot to contribute. Age discrimination has a special feature: it is the only kind of discrimination where those who perpetrate it will themselves eventually be victims of it.”
The diabetes expert said, “I go to work every day, doing research with my team in the lab. I try to stay in the territory between clinical medicine and laboratory research. I speak to other doctors and present medical grand rounds quite regularly. I work with pre-med students who want to do research in medical fields as well as become physicians.”
Roth no longer directs care for individual patients but is working with Israeli researchers at Tel Aviv University to devise methods to diagnose diabetes at earlier stages of the disease.
Roth was born in 1934 into a modern Orthodox family in Brooklyn’s Boro Park section, which is now almost totally ultra-Orthodox (haredi). “My father, who was born in the US, sold wholesale children’s and women’s wear. My grandfather died when my father was 12. He supported his family from then on. My mother, who was born in Romania, was a housewife, very smart and hardworking. My older (late) sister, a teacher at Brooklyn’s Yeshiva of Flatbush, and my younger brother, a government lawyer, completed the constellation.”
Even then, half of the Boro Park’s residents were Jewish and the rest Italian Americans.
“We never wore our kippot outside of the house, only a sailor hat or baseball cap.
Our tzitzit didn’t show either.” he recalled.
“It is refreshing today to see the modern Orthodox in the US who feel safe with the signs of their observance out for all to see.”
Roth received his medical degree from Yeshiva University’s Albert Einstein College of Medicine in New York in 1959 (when tuition was $1,000 a year) and was trained in internal medicine at Barnes Hospital at Washington University in St. Louis. Prof.
Irving London, the founding chairman of internal medicine at Einstein – who is a nonagenarian today – arranged for Roth’s move to a lab at the Bronx Veterans Hospital to continue his studies. There, Roth had the fortune to work as a laboratory fellow with MD researcher Dr. Solomon Berson and future Nobel laureate, Ph.D. researcher Dr. Rosalyn Yalow.
At that time, insulin was the lab’s research focus and Berson and Yalow had just created the first radioimmunoassay, using it for the first time to measure insulin in patients’ blood. Later, work led to radioimmunassays for other hormones, including growth hormone, corticotropin, parathyroid hormone and gastrin. Berson died of a heart attack in 1972, but as the Nobel Prizes are not awarded posthumously, Yalow alone received a Nobel Prize in Physiology or Medicine in 1977 for their joint work on the radioimmunoassay.
Another laboratory fellow, a partner with Roth at the Bronx Veterans Hospital, was Dr. Shimon Glick, now emeritus professor and former dean at the Ben-Gurion University School of Health Sciences. Together, the team of four succeeded in introducing new tests for diagnosing disorders of growth hormone secretion that remain the gold standards in the field today.
“Jesse is an amazing guy, cultured, kind, honest, a mentsch and with a great sense of humor,” Glick recalled recently for the Post. “We worked together day and night for two years in Berson and Yalow’s lab.
Since then, he has made major advances in the understanding of diabetes and he has helped many young Israeli researchers who came to his lab.”
Roth met his wife Susan in Washington when he was working at the National Institutes of Health in Bethesda. “It was the early days of the civil rights movement.
Susan was a teacher in the Head Start Program to help socially disadvantaged preschool children, and I was a member of the Medical Committee for Human Rights, a national organization of health professionals that supported the advancement of civil rights.” Early in their marriage (1971-72), the couple spent a year in Jerusalem and lived in the Talpiot quarter while Jesse did research at the Hadassah University Medical Center and Hebrew University.
In recent decades, Susan Roth has been a successful author of children’s books. Their three adult children are Alisa, a broadcast journalist (including a seven-year tour with National Public Radio); a son, Alex, who works in the public service sector as a lawyer in Oregon; and Alana, also a newly graduated lawyer, who provides legal aid in the Bronx.
“My mother’s cousin and a cousin-in-law, both MD’s, were role models for me. I liked science early in grade school and at Columbia studied in the pre-med track. I recall a lot of time in the library, reading a lot about how cells talk to one another.”
His Orthodox parents were pleased he chose to attend Einstein, America’s first medical school under Jewish auspices.
“It was a marvelous educational experience.
The faculty and student body were both very special. At most other medical schools, there were quotas that limited the number of Jews admitted. Even stricter quotas limited racial minorities of all stripes and women.” Now, US medical schools are actively courting members of racial minorities. Women now constitute about half of medical school graduates in the US (as in Israel). “They are excellent.”
Asked if he thought female doctors are more humane to patients than their male counterparts, Roth cogitated: “I don’t know, but an interesting question that would be worth studying.
Between 1963 and 1991, Roth researched diabetes and other disorders at the US NIH’s National Institute of Diabetes and Digestive and Kidney Diseases and eventually became its scientific director, with the rank of assistant surgeon general. In the early 1960’s when he joined the NIH, the war in Vietnam was heating up. “We were very nervous about being drafted and sent to war. Many young MDs took any job they were offered at the NIH – or any government appointment that shielded them from Vietnam. Luckily, I was given excellent advice. The NIH post that I was appointed to brought my career great momentum. I feel I had an angel watching over me,” Roth added.
In 1991, Roth moved to Baltimore, Maryland as the Raymond and Anna Lublin Professor of Medicine and Geriatrician- in-Chief at the Johns Hopkins University School of Medicine and served as director of its division of geriatrics and gerontology.
In 1998, Roth moved to New York, where he continues as researcher and head of the Laboratory of Diabetes and Diabetes-Related Disorders at the Feinstein Institute for Medical Research of the North Shore-Long Island Jewish Health System and professor of medicine at the Hofstra North Shore-LIJ School of Medicine. Since 2000, he also serves as professor of medicine at Einstein (which recently merged with Montefiore Medical Center in the Bronx).
Roth is best known for introducing breakthrough methods and concepts for the direct study of cell-surface receptors for insulin and other hormones. He and his NIH colleagues published pioneer work on patients with inborn as well as acquired defects in the insulin receptor that paved the way to understanding that many human disorders are linked to defects in cell-surface receptors. “We now understand that for any hormone or hormone-like messenger to work on any cell, the cell must possess (usually on its surface) a receptor molecule that recognizes that hormone (and no other) and combines with it. The receptor then becomes fully activated, turning on a full program of actions in the cell that we associate with that hormone. This binding has been described as a ‘lock and key,’ but that is probably oversimplified.”
Roth notes that, “communications between cells are very important. By now, more than 1,000 different receptors have been discovered. I am confident that more will be discovered, some will be ‘orphan receptors’, so-called because we might not know at the time of their discovery what turns them on. Many diseases are associated with too many or too few receptors. In other disorders, one receptor type is turned on continuously even in the absence of its partner hormone. In another set of disorders, the receptor is present but cannot be turned on by its proper hormone.”
The famed endocrinologist has heard about the preliminary discovery by Weizmann Institute scientists that mice who received calorie-free artificial sweeteners, like those used by patients, could actually have an accelerated onset of glucose intolerance . These findings may explain in part why artificial sweeteners in general have not generated much improvement in patients with obesity or hyperglycemia.
Roth speculates that the consumption of sweeteners, natural or artificial, raises the bar. “If you start to consume a lot of sweetness, you desire and expect more sweetness, and this affects the taste receptors. Sweetness from artificial sources turns on the same receptors as sugar,” he explained.
Roth is optimistic about the benefits offered by bariatric (stomach-shortening or –narrowing) surgery for diabetes, especially for those who are highly overweight.
While these operations have been found to alleviate or even cure diabetes among some patients who are not so overweight, Roth is awaiting longer-term studies of the benefits and the negatives. “The surgery was originally thought to reduce calorie absorption from the intestine, but now we know the surgery causes changes in hormone signals.
In the next decade, scientists will surely figure out the changes caused by bariatric surgery and see if the same result can come from hormone therapy for diabetes rather than from operations.”
The best way to put a dent in the diabetes epidemic is “to control weight, balance your diet and exercise more,” he continued.
“I was a skinny child, but then I got heavier.
With dieting, most people can lose 5% of their weight and maintain it. I myself have cut 10% of my weight in recent years. I recommend weighing yourself every morning and keeping a written record to keep an eye on it.”
As for his life and career, Roth sums up that as a person, a doctor and scientist, “every day is Thanksgiving Day.”