When the Doctor is Also the Patient

Paul Lange, M.D., is a urologist and researcher — now almost retired — who made major inroads in identifying and treating prostate cancer. Irl Hirsch, M.D., is one of the world’s foremost authorities on type 1 diabetes. Besides being at the top of their fields, what do these two UW Medicine faculty members have in common? They have the conditions they study. They also have some inspiring things to say about treatment for cancer and diabetes.

When did you find out that you had cancer?
Lange: I was involved in refining and testing the PSA (prostate-specific antigen) test prototype and helped to get it approved by the U.S. Food & Drug Administration. So I started doing yearly PSA testing very early. In 1999, when I was 41 years old, I realized my PSA was increasing. I got a biopsy and discovered that I had prostate cancer. I was a little scared, which shocked me because I had been treating prostate cancer patients for so long. Fortunately, I was pretty sure that I had a very early case and would probably be cured with surgery. Now, with cases like mine that grow very slowly, we closely monitor tumors before we operate.

When did you find out that you have diabetes?
Hirsch: I was 6 years old when I was diagnosed with type 1 diabetes, so I don’t have many memories of it. (I remember more clearly when my brother, James Hirsch, was diagnosed; at the time, he was 15, and I was 19.) My parents were told that I probably wouldn’t make it to age 30. You almost can’t explain to a parent who hasn’t lived it — how this diagnosis is going to change your child’s life.

Has having cancer changed how you approach research or patient care?
Lange: I became better at sympathizing with patients. I talk to them a little differently. And as soon as they find out that I have been through it, too, they probably listen a little better. Having had prostate cancer made me a better spokesman for the disease and for the necessity of men getting checked and treated.

It also galvanized me to do more research and to focus on creating the Institute for Prostate Cancer Research (IPCR), a collaboration between UW Medicine and Fred Hutchinson Cancer Research Center. It’s now one of the more prominent research centers in the country for prostate cancer.

What drives you to help other people with diabetes?
Hirsch: My answer to this questions has changed over the years, but today, it’s simply to get as many people as possible the best treatments. Even now, every day I see people with less than state-of-the-art diabetes care. Everyone should be as fortunate as me. And while socioeconomic status would seem to be the main determinant of who gets good diabetes care, surprisingly, that isn’t as important as you would think. It comes down to the individual provider and the system where a person gets their care. That’s just as important, if not more so.

On a side note, I don’t talk about the fact that I have diabetes with my patients, unless they bring it up. Sometimes the younger patients will say, “Well, you don’t know what it’s like.” And I say, “I think I do, actually!”

How has care changed over the years?
Lange: It’s a revolution in terms of what we know now about prostate cancer. I keep telling patients, when I first started in urology, men with testis tumors, like Lance Armstrong, would’ve been dead in a month. And now most of these men are cured. The same thing will happen in prostate cancer. Already, life expectancy has gotten a lot longer for men with advanced prostate cancer.

Hirsch: Back when I was in high school, all diabetes care was the same — bad. The statistics were grim: 50 percent of diabetes patients developed retinopathy and would go blind; a third developed kidney disease and would probably perish from that. Today, the level of diabetes patients with eye disease is under 10 percent, and patients with kidney disease is around 2 percent. If you come into my clinic with a child who was diagnosed with type 1 diabetes, I can tell you that your child will most likely have a normal lifespan. That’s not what my parents were told.

What are you most proud of?
Lange: I think we’ll soon be able to better control and cure prostate cancer. The IPCR’s role in that is something I’m really proud of. I’m also very proud of our team and the fact that the IPCR plays a significant role nationally in terms of prostate cancer research.

Hirsch: We have a brand-new adolescent transition clinic. As kids transition their care from the pediatric clinic to the adult clinic, they need additional services, including more mental health services. This was an idea that a colleague and I had over 20 years ago — now it’s a reality.
Just this morning, I saw all these kids with tattoos and fluorescent hair walking around the clinic, and I thought, this is exactly what I envisioned. This is awesome!

Accelerate Medicine

Through a gift to the UW Medicine Diabetes Institute Fund or the IPCR Research Fund.

Irl Hirsch, M.D., is a UW professor of medicine in the Division of Metabolism, Endocrinology and Nutrition, the medical director of UW Medicine’s Diabetes Care Center and the Diabetes Treatment and Teaching Endowed Chair. He received the Endocrine Society’s Outstanding Public Service Award in 2018.

Paul Lange, M.D., is a UW professor emeritus and former chair of the Department of Urology, former director and founder of the Institute for Prostate Cancer Research, and the past holder of the Pritt Family Endowed Chair in Prostate Cancer Research. Dr. Lange was honored twice in 2017: with the Société Internationale d’Urologie’s Distinguished Career Award and the Keyes Medal, the highest honor bestowed by the American Association of Genitourinary Surgeons.

Share: