A Bangladeshi doctor and his theory to prevent diabetes
“Diabetes is a global pandemic. I was a physician and eager to know the root causes of diabetes,” Dr Madhu told The Business Standard during a recent interview
Madhu Sudan Malo was a bookworm since childhood. He used to confine himself to a corner of the playground and read books while all his friends cheerfully engaged in play and sports.
The books shelved at the Suapur Nannar High School library were his treasures. Before he finished his eighth grade at the village school, he had already devoured around 500 books.
Then one day he came across a book on George Washington Carver – the prominent Black American scientist of the 1920s who promoted alternative crops to cotton and methods to prevent soil depletion.
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This was perhaps the most important book in Madhu's life.
"If a man from the Black community could become a scientist, why can't I?" a young Madhu wondered.
That was the beginning for the budding scientist from the marginalised Malo community in Bangladesh.
On 23 March this year, the global community got to know that Bangladesh-born scientist Madhu S Malo had led a research team which proved the theory that deficiency of intestinal alkaline phosphatase, IAP in short, causes diabetes – the disease that 10% of the global population suffers from.
"Diabetes is a global pandemic. I was a physician and eager to know the root causes of diabetes," Dr Madhu told The Business Standard during a recent interview.
Citing that around Tk46,000 crore is spent every year in Bangladesh for diabetes treatment, he said that people's IAP deficiency can be diagnosed by spending only Tk600 crore.
Hence, early diagnosis of IAP count could save a huge amount of money.
The new findings
In 2013, while Madhu was serving as a faculty at the Harvard Medical School, a French group showed that lipopolysaccharides (LPS) – toxins found in gram negative bacteria – cause insulin resistance when those enter the bloodstream.
Insulin resistance means hyperglycemia or diabetes for humans.
At the time, Madhu was analysing the IAP – an enzyme secreted from duodenum. The function of the enzyme is to destroy the toxin LPS.
That's when Madhu developed his theory.
He experimented with some laboratory-generated mice which didn't have any IAP gene.
According to the theory, the mice had no powers to destroy the LPS.
Madhu called Kanakaraju Kaliannan – a post-doctoral fellow – to check the mice's condition.
Kaliannan learned that the mice developed not only diabetes but also hypercholesterolemia and hypertriglyceridemia (fatty liver), which are signs of heart disease.
Scientists call the situation metabolic syndrome.
"That time we proved that IAP deficiency is responsible for metabolic syndrome. That was the start of 2013. Metabolic syndrome precipitates diabetes and heart disease," Madhu said.
Later, he left Harvard and started human research. He also knew that conducting research in Bangladesh would be much cheaper than doing so in the US.
"I thought any study on diabetes in Bangladesh should be collaborated with the Diabetic Association. I communicated with Professor AK Azad Khan, president of the association. He gave me the green light," Madhu recalled.
A research team was formed with a pool of experts.
As he had the theory and findings from the animal studies, the team launched a human trial in Savar.
At the beginning of the study, persons with no diabetes were included. Some of them had less than 65 units of IAP, some had more.
"After five years, we observed that those who had the lowest persistent IAP also had the highest level of diabetes incidence and those with the highest IAP had a minimum level of diabetes.
"The most interesting part was that some of the people having lower IAP had increased their IAP level and didn't develop diabetes," Madhu said.
He, however, didn't know how the IAP level went up.
"Probably further studies might be needed. We need to know the person's socio-economic status, food habits, exercise patterns and other things. But that study will need a huge budget," the scientist said.
Birdem General Hospital's endocrinologist Professor Faruque Pathat, BSMMU Professor MA Hasanat, UGC Professor and hepatologist Salimur Rahman, John Hopkins Professor Abdullah H Baqui, Boston University Professor Abu Abdullah, Jahangirnagar University Professor Salequl Islam, Rajshahi University biostatistician Dr Jahangir Alam, Jagannath Malo, Birdem's Abdul Mottalib, Md Mehedi Hasan, Ginok Barmon, Shamema Akter Tinni, Swapan K Barman, Tapash Sarker and Nayeemul Islam Khan took part in the research.
Inheriting philosophy to serve people
Born on 1 September 1953, Madhu has always been driven by a need to serve the community. He said that his father Tara Sankar Malo influenced him the most.
According to Madhu, his father stood out among others.
Tara Sankar was the first in his community, as well as locality, who passed matriculation in 1947. Then he went to Calcutta (Now Kolkata) and took a job there that offered him Tk240 salary. The salary seemed huge at that time.
But he did not continue the job. Why? At that time, Tara Sankar's grandfather Durga Charan Malo established a primary school in Betuail, a neighbouring village of Suapur. But the school had no teacher. Tarsangkar came back and took charge of the school. His salary was only Tk25 there.
"My father had that type of philosophy and probably I inherited it a bit," Madhu recalled.
Tara Sankar served as the head teacher of the primary section of Suapur Nannar High School. His colleagues used to take care of Madhu. But they also loved the meritorious boy. Often they gave money to Madhu to buy sweetmeats.
"The teachers, including my father, encouraged me the most to read books. They had a great influence over me," Madhu said. Madhu dedicated his PhD thesis to his teachers.
He said his mother Premada was a very intelligent lady who brought up six children with great care.
Despite having a short stint in school herself, Premada always inspired her children to get higher education. And all of her children satisfied their mother in this regard.
Molecular biologist who wanted to be a physicist
With a stipend, Madhu enrolled at Singair High School in Manikganj district as there was no science division in the Suapur school.
The science-loving boy secured the highest marks in physics in the 1968 Dhaka board matriculation.
"I was good at physics and I wanted to be a physicist. But my family members warned that I would not get a good job with a physics background. And they insisted that I become a physician," Madhu reminisced.
He got enrolled in Dhaka Medical College in 1970. After completing his MBBS, he followed some of his classmates in embracing overseas employment in Iraq.
Madhu had been posted as a paediatrician in Basra. He served his best but his desire to become a scientist never faded. He kept exploring options for higher education.
Living in Iraq, it was quite impossible for him to communicate with universities in the US. So the paediatrician wrote to the English-speaking university teachers in Australia, Canada and England.
"I collected two reams of paper from Baghdad. Every day, after I finished seeing my patients, I used to write 10-12 letters. Typewriters were not allowed. So the letters were handwritten," Madhu said.
He got chances to do PhD in Laval University in Canada and Oxford University in England. He also got a chance for his PhD in paediatrics at the Monash University in Australia. The university offered him a good salary of 64,000 Australian dollars per annum.
Madhu then began taking preparations to go to Monash.
Madhu said, "At the time, the Iraq-Iran war was going on. It was also a period when genetic engineering was at an early stage. I was very interested in that. I read books about it. I listened to five lectures from BBC radio on molecular biology. That made me crazy. The same time I received an offer from the biochemistry department of Sydney University to do my PhD on molecular biology. Despite it being a self-financed study, I changed my mind about Monash and opted for Sydney University."
Madhu financed the two years of the PhD programme with his own savings.
One day, his head of the department Philip Kutchel came and said, "Madhu you will get the scholarship because there are eight scholarships and your position is sixth."
That was the preliminary selection. Later, in the final selection, Madhu's name was not in the list because he was not Australian.
"Philip went to the VC and convinced him about my scholarship. I could then complete my PhD successfully," Madhu said.
Sweet and sour family life
The Sydney University offered Madhu a scholarship worth 15,000 Australian dollars. His friends demanded a big celebration party from the young man.
In Sydney, a Bangladeshi lady named Lamia, also a doctoral candidate in the department, was a roommate of an Australian girl, Judith.
When Madhu called the celebration party, among others, Lamia and Judith were also invited. The Bangladeshi man and the Austrian girl got formally introduced. It was sometime in December 1985.
"Then Valentine's Day came. I asked Judith out on a date. She agreed. Days rolled by and we fell in love. Finally, we got married in 1986," Madhu said.
He finished his PhD in 1988. The next year, the couple gave birth to their beautiful daughter Premoda.
In 1990, Madhu went to Massachusetts Institute of Technology (MIT) for his post-doctoral fellowship.
Judith and Premoda often enjoyed playing on the MIT garden premises, a fond memory which Madhu still treasures.
But good things don't last forever. The couple's marriage came to an end in 1999, by which time they had another daughter, Nondita.
Although cracks had appeared early on, the couple persevered for as long as they could.
At present, Judith lives in Sydney with their daughters. Premoda is studying law, while Nondita is doing her post-doctoral degree in marine biology in Sydney.
About Judith, Madhu said his ex-wife is a very decent woman and the two remain friends till this day.
In 2003, Madhu married a woman named Kabita Sarker, a high school teacher, from Gopalganj. Her father was Prof Keshob Chandara Sarker and mother is Rama Rani Sarker, a retired primary school teacher. Madhu and Kabita have two children: Keshob and Debika.
The family are living in Boston, Massachusetts.
What will be next?
The study that Madhu and his team has established suggests that IAP deficiency is the major cause of diabetes. And it can be easily traceable to find who are suffering from IAP deficiency.
The whole procedure will take only three minutes.
The IAP deficient patients all around Bangladesh can be diagnosed in a single day, Madhu says.
"Then, we can advise the people on what kind of precautions they need to take. I believe IAP deficiency is a preventable condition, and hence diabetes can be prevented," Madhu said.
However, the scientist doesn't know whether the Bangladesh government is going to do anything with this scientific knowledge.
"They know about this discovery. We are trying to convey it. Let's see what happens," Madhu concluded.
