A few days ago, I met with a professor at Weill Cornell Medicine school here in Doha. There’s an area of Doha called “Education City,” which is a collection of American university campuses here – Cornell, Texas A&M, Carnegie Mellon, and more. Created by the government non-profit organization Qatar Foundation, Education City is part of Doha’s commitment to being “the best” and a step towards being a knowledge economy. The Weill Cornell school is Cornell’s third campus (with the second being the Weill Cornell Medicine school in New York City), and it is the first overseas campus of an American medical school. The Cornell professor, who is also a doctor, was brought in two years ago to establish clinical research in diabetes and its associated complications. Diabetes is one of Qatar’s most pressing medical issues.
As the doctor told me, “in a place like Qatar, there is a huge investment in wanting to be the best, and the hierarchy truly believes that.” That is, Qatar’s wealth – it is currently the richest country in the world – is quite recent, and the government is spending lots of money to have the best education, the best hospitals, skyscrapers, and so on. By the hierarchy, he meant the Qatari ruling family. They fund the Qatar Foundation, which has many projects in addition to the impressive Education City. The professor told me that the Qataris seem to be genuine in their vision to develop something long term rather than short term, aware that their wealth cannot always come from oil and that solutions have to come from within (thus Education City; it’s important to educate the younger locals so that innovation comes from within rather than from imports).
We spoke about how obesity and diabetes are the “mega health challenges” in Qatar. I asked what the main contributing factor is, and the doctor said “rapid modernization.” Qatar has developed from a population of a few hundred thousand 30 years ago to a population of 2.3 million people today, most of them expatriates. While some expats bring their diseases with them, the main reason diabetes is such an issue now is because of how much the local lifestyle has changed in those 30 years. The doctor told me that the previous generations – those that predate Qatar’s booming wealth – would often live off one meal a day and do physical work for a living. Now, there is a McDonald’s on every corner and no need to do physical work. The lifestyle changed far faster than genes change, and the locals’ genes are still adapted to the worker lifestyle. Thus the professor gave an evolutionary argument: years of genetic programming made the Qataris “fuel efficient” (that is, with a slow metabolism), and so now they are flooding their systems with an excess of fuel.
This argument came with a warning. Genetic profiles evolve very slowly, and one way genes get changed or renewed is when entire populations (gene pools) are killed off by disease. The doctor is worried that because of diabetes, heart disease, stroke, and other complications, newer Qatari generations will die before they are able to pass on their genes. “It’s Darwin’s finches,” he said.
In addition to factors of modernization and evolution, there are cultural and social reasons contributing to the diabetes epidemic. The professor said that food is how people socialize here: they leave their air-conditioned homes, get into air-conditioned cars, and meet their friends at air-conditioned restaurants. The lack of movement and focus on food leads to eating far more than necessary. Another aspect is a certain passivity to illness amongst the Qatari locals who get healthcare for free. The doctor said that, all over the world, very few people become motivated to make major changes to their diet and exercise until something serious happens, such as a heart attack. In Qatar, there’s an added element that the locals can get bariatric surgery for free. So they have this attitude that if something happens, they’ll just get the surgery and be fine. The doctor described a 35-year-old patient of his who is overweight. She isn’t obese, but she had gestational diabetes during her pregnancy and is now diagnosed with diabetes. She came into his office the other day, and “the only thing on her agenda was not to improve her blood sugar levels. It was ‘Doctor, I want to have bariatric surgery.’” He was a bit taken aback – while bariatric surgery works, it’s not something you should want to do within 5 months of a diabetes diagnosis. But since it’s so easy to get free bariatric surgery, there is less motivation to prevent yourself from needing that surgery.
It’s so interesting how the same structures can have completely different outcomes in separate environments. Healthcare is also free in Sweden, essentially, but people there don’t use the system to have extreme surgeries. This is why I’m doing this project – it’s so important to know how all these country-specific factors (social, historical, political, cultural, etc.) interact to understand why certain outcomes occur.
Overall, diabetes and obesity result from the lifestyle choices associated with rapid modernization. “They’re over-nourished, under-exercised, and that’s it,” said the doctor, saying that people even complain about walking from the parking lot. (Speaking of: I saw an IKEA truck the other day and found out that there is an IKEA just north of the city. I looked it up online, excited to see some of Sweden here in Qatar, and found a negative review of the place. With a summary of “Too much walking,” the reviewer explained how IKEA has arrows on the floor to show the path through the store and warned visitors to “be prepared for a workout.” Sure, IKEA is big, but I would never see such a review in Sweden!). The professor pointed out that there are obese people in the U.S. and the U.K. too, though, for similar reasons – with money and constant access to food, it can be hard to avoid that burger or those chips, and people find all sorts of reasons not to go to the gym. Even though they have open access to technology, and communication and education through the internet, it can be hard to make the healthiest lifestyle choices.
One reason I wanted to go to Cornell specifically is its relationship to Hamad Medical Corporation (HMC), the main hospital system in Qatar. The professor said that the Qatar Foundation is trying to replicate the setup in New York City, where the Cornell medical school shares knowledge, patients, and resources with the NewYork-Presbyterian hospital nearby. The professor said that all good clinical health centers require academics and research in order to accelerate drug discovery, diagnostics, testing of novel treatments, and more. However, he finds that the research drive is missing in Qatar. While Hamad is a very good hospital providing a good service, it’s behind in terms of state-of-the-art clinical research. The doctor stressed that this was a fact and not a criticism – “they don’t like it when we say it” – but as a clinical academic, he gets frustrated that he doesn’t have a method of doing cutting-edge clinical research and developing and testing new technologies and treatments for patients. It’s not a lack of money, and rather a lack of seeing the bigger picture; but by bringing in clinical researchers like the doctor I met, HMC seems to be moving in the right direction.
I find it fascinating that the government is investing so much money in being “the best,” and yet this doctor runs into people at HMC who don’t like to hear about the areas that need improvement. I think a full commitment to being the best in something requires being open to external constructive criticism. It’ll be interesting to see if this comes up in areas other than health.