Demystifying diabetes

For Clay F. Semenkovich, M.D.,compassion and perspective are keys in research and patient care

By Gila Z. Reckess

Clay F. Semenkovich, M.D., always was an avid reader and gifted literature student, but the two biggest lessons he learned in high school English class had nothing to do with Twain or Thoreau.

Photo by Bob Boston

Clay F. Semenkovich, M.D., profoessor of medicine and of cell biology and psychology, and longtime patient Gwyneth McKee discuss treatment options. Semenkovich has dedicated his career to examining the connectioin between diabetes and heart disease.

Socially ostracized in his southwestern Virginia school, Semenkovich fell prey to the angry temperament that often accompanies adolescence. One day, his 10th-grade English teacher, Sue Banner, reminded him of a verse in the Bible: Judge not lest you be judged. She complimented his academic gifts but warned him of the burden of having such talents.

"Mrs. Banner taught me that you need to be very special about using your gifts," Semenkovich recalled. "She helped me realize that other people may be less fortunate than me and inspired me to use my energy compassionately to help folks instead of being angry."

The following year, Banner died. Suffering from uncontrolled diabetes, she spent her final months blind, unable to read the books she had planned to enjoy during her inevitable decline. She passed away as most people in her condition do -- short of breath with a failing heart.

And so the young Semenkovich learned a second lesson that most of the world has yet to understand: Heart disease and diabetes are inextricably linked.

"I was haunted by Sue Banner's death," he said. "And I thought, 'Wouldn't it be interesting to try to make some contribution to decrease the burden of folks like that.'"

That's precisely what he's done. Now professor of medicine and of cell biology and physiology in the School of Medicine, Semenkovich has dedicated his career to helping unravel the mystery of the connection between diabetes and heart disease.

The academic talent Banner noticed and the compassion she helped inspire are manifested in Semenkovich's approach to medicine, from research to education to patient care.

"Clay Semenkovich's research is highly productive," said Philip E. Cryer, M.D., the Irene E. and Michael M. Karl Professor of Endocrinology and Metabolism. "He is beloved by his patients, and he is an award-winning teacher of medical students, residents and fellows.

"He is really a bright guy and is very energetic and enthusiastic -- just the kind of person we want on our faculty."

Likewise, Semenkovich feels Washington University was the best thing that ever happened to him --primarily because he met his wife, Janice W. Semenkovich, M.D., now associate professor of radiology, on the first day of medical school. The two married at the end of their second year and spent their "honeymoon" by starting their grueling third year.

Courtesy photo

Clay and Janice Semenkovich with son Nicholas and daughter Katherine.

But it's the University's successful integration of his three values -- research, patient care and teaching --that inspired Semenkovich to stay here after medical school, first as an intern, then a resident, fellow, chief resident and finally as a professor.

"Medicine is the most wonderful thing you could ever do with your life, but it's also an important responsibility," he said. "I feel blessed to be here, and in return I think it's absolutely essential for physicians here to see patients, transmit our love of knowledge and enthusiasm for science to the next generation, and remember that the reason research is so important is because it helps decrease the burden of disease."

According to Semenkovich, what makes this institution exceptional is that the people here simply "do the right thing." For him, that means keeping focused on what's most important: patients.

"The most valuable gift you can give someone is to pay attention to him or her," he said. "Nobody fits an algorithm. You really have to talk to people to figure out how you can help them in the context of their lives, not your own."

To do so, Semenkovich makes sure to be cheerful when he's in the clinic and tries to make patients feel comfortable and happy about being there. He often surprises medical students by candidly appealing to his patients, saying, "We care about you and we want this to work -- please tell us what's wrong," a lesson, he says, in the value of opening yourself up rather than simply attacking the problem independent of the patient's thoughts.

At the end of each visit, Semenkovich gives his patients a small index card with specific, simple guidelines to follow, including instructions such as stopping a drug regimen if side effects arise.
"It's easy to assume people know things that they actually don't," he said. "I always try to think about how to express things in a way that ultimately will make patients get better care."

Patients also are what motivate his research.

Clay F. Semenkovich, M.D. University title: Professor of medicine and of cell biology and physiology Family: Wife, Janice W. Semenkovich, M.D., associate professor of radiology; children, Nicholas, 15, and Katherine, 11 Hobbies: Reading, hiking, cycling, running, tennis

After completing his chief residency in 1987, Semenkovich took an unusual career turn: He went back to school. While serving as an instructor in medicine and cell biology at Baylor College of Medicine in Houston, he learned how to be a molecular biologist.

According to his mentor at Baylor, Lawrence Chan, M.D., the Rutherford Professor and chief of the Division of Endocrinology and Metabolism and professor of molecular and cellular biology, it truly was a symbiotic relationship.

"Clay is a wonderful person with a unique sense of humor, and his lectures were quite lucid and thought-provoking," Chan said. "I am sure I learned as much from him as he did from me -- he was destined to be a leader in the field."

Equipped with everything he needed to begin the research he had dreamt of since learning from Banner about the devastating effects of diabetes on the heart, Semenkovich returned to Washington University in 1990.

He then began to study muscle genes for clues about what happens during exercise, hoping to mimic those processes in individuals incapable of or unwilling to perform traditional exercise. By applying some of these findings, Semenkovich recently engineered a strain of mice that can eat a high-fat diet without gaining weight or developing insulin resistance, the precursor to diabetes.

His team's recent observations also suggest that these mice do not develop clogged arteries. Though the animals didn't exercise at all, they were reaping the benefits of traditional physical activity, thanks, in theory, to the fact that they could produce a protein called uncoupling protein-1.

Despite their abnormally fast metabolism, the mice used in this study, published in Nature Medicine in October 2000, appear to be quite healthy. Semenkovich's team just received a five-year, $1.25 million grant from the National Institute on Aging to measure the life span of these animals.

The results could answer an age-old question: Is life span determined by a defined number of heartbeats? On the one hand, the mice burn fuel unusually quickly, which could overly tax the heart. On the other hand, they don't have excess toxins such as insulin and glucose cycling indefinitely throughout their bloodstream.

Semenkovich predicts that the composition of their blood will be the determining factor in their life expectancy, not the number of heartbeats or the amount of fuel burned.

While trying to develop new treatments and medical theories in the laboratory, Semenkovich also focuses on raising awareness of this issue through active involvement in national organizations such as the American Diabetes Association and the American Heart Association. He also encourages his patients and other physicians to recognize the role of lipid-lowering medications, aspirin, and, the most important component, exercise.

He doesn't just talk the talk either. Every day, Semenkovich tries to do some form of exercise with his wife and two children, whether it be cycling, tennis, running or hiking, either locally or on the family's annual trip to the Appalachian Mountains.

He also still manages to make time for what he sees as the best mental exercise -- reading. As his final tutorial at the conclusion of each of his students' training, he gives each a book with a personal inscription.

"Reading literature is absolutely critical to developing a perspective on how to provide the best clinical care," he said. "Anybody can read in a textbook how to give insulin, but that's very different than taking care of patients."

And so, with personally chosen books and sincere words of wisdom, Semenkovich passes on Sue Banner's message to his students, teaching them his most cherished life lesson: perspective.