Alka Kanaya, M.D.

1. Who are you?

I’m a clinical investigator and professor of medicine at UC San Francisco.

2. What are the issues you fight for?

I am passionate about having representation of Asian Americans in medical research and about having data to guide our health policy and what we do in medicine, based on people who are represented in studies. And so my goal with my research is to generate data to show how different Asian American groups are - we have been aggregated in one monolith when there are over 20 different groups, and those groups are very different from each other individually! I’m in the business of generating data to make these distinctions between different Asian groups clear. Overall, my passion is to give voices to Asian American subgroups that have been neglected.

3. How did you get here?

I’m the first of my family to go into medicine. I was interested in medicine primarily for clinical patient care, and I’ve been at UCSF since medical school; I chose to go into primary care because I liked having longitudinal relationships with my patients and their families, and getting to know the whole person over many decades.

Really, my patient care experiences have fueled my interest in research, because I saw many patients who were having terrible complications with diabetes as a med student and resident, many of whom were ethnic minority group members, many from Asian American communities. And we really didn’t know much about how these groups, if treatments should be tailored any differently, how to prevent these chronic diseases in the community. That just struck me as a major gap in knowledge, and I just thought we have to do something about this, because we can’t do anything without proper information.

I took a major turn in my career as a resident, when I worked on a research project to understand how we can predict TB where the sputum stain is negative, and it was a great introduction for how we can answer a question with data - it just opened up a whole new experience for me. I decided to do a research fellowship in general internal medicine also at UCSF, and I knew I wanted to focus my research on diabetes: it’s a passion for me because it is so prevalent in my family, my community, and in my patients. I have seen a lot of devastation caused by type 2 diabetes.

I found it hard to get started because there weren’t very many faculty in UCSF who do clinical research around diabetes. There’s a lot of basic science research on type 1, but not much in clinical research around type 2. So I had to cast a wide net to find research mentors outside of UCSF, and I found one at UCSD, even though it was long distance. From then it’s been a tireless effort to keep going in this track - it took a total of 5 tries to get my first grant on South Asians. Since then, I have been working on developing what we need to know, and what we can do together with this community and for this community.

4. How does activism/advocacy fit with your role in medicine?

It’s about disseminating the research and educating people about different ways of understanding risk factors for different groups. It’s not just about generating the data about this ethnic group that is very different than other groups, but it’s about using the data to inform the community about how to make better decisions around their healthcare and the lifestyle choices they make. And then, having that data to help guide health policy.

What we found in our study to change the way doctors and health policy makers think about risk in Asian American communities. We recently published a paper in JAMA where we disaggregated Asian American groups in a national study that’s done every 2 years, and we showed that there’s so much variation among Asian Americans and you have to disaggregate this to see who’s at really high risk for diabetes. This kind of work has really opened the eyes of many people, because Asian Americans are not thought to be high risk because of smaller and slimmer body sizes, and that’s so far from the truth - South Asians, Filipinos, and some Southeast Asian groups as well, are actually some of the highest risk groups.

We’ve also done a big Screen at 23 campaign working with the National Council of Asian Pacific Islander Physicians; when we put our data from South Asians, East Asians, and Southeast Asians together, we showed that Asians develop diabetes at a much lower BMI - 23 instead of 25, and we really need to screen Asians at 23. We had health organizations adopt this resolution that they’re spreading through their community and educating health providers about. The American Diabetes Association has adopted this guideline of using 23 as the BMI cut-point for screening Asian Americans for diabetes.

My role in medicine is to be a clinician and also be an educator to my peers and to my community at large, to help people. It’s not just about the papers you write, the citations you get, the tweets that get retweeted, or the Facebook posts that get liked. It’s about really affecting people’s lives and making them healthier.

5. How does your AAPI identity influence your advocacy, if at all?

I’m an immigrant - I was born in India and moved to the US when I was 6 years old, and I identify as Asian American. I think growing up bicultural and adopting the best of both worlds has really influenced my advocacy, because I see people who do live in both worlds or in only one of those worlds and how their culture or their society can influence their health. with that perspective, I’m able to code switch - which I do often when I’m working in the community, I can be an insider.

6. What are some challenges you've faced in your work?

The challenge is constant. It’s having people take you seriously and what you’re doing seriously, and having funding for the work you want to do and having it sustained. I just received a bad score on another grant today - it’s all about persistence in this academic line of research that we’re in. You’re constantly getting bad news, tough criticism, and you have to develop resilience in the biggest way. I’m thankful to be able to laugh after a bad score now, because it’s crushed me many times! It’s all about the passion that drives you.

7. What's your advice for health students getting into advocacy?

Get involved as soon as possible, because you don’t know if it’s for you unless you try it out - seeing what work with the community is like, what the day to day academic research life is like. Whether it’s for outreach or education, or it’s actual research recruitment or follow up, or just other advocacy work, there are so many different ways you can get involved in whatever community is of most interest to you.

Reach out to people not too far away or even those across the country - I have people reaching out to me from all over the country to spend a summer working with our group, and you can even schedule it as part of your training to have an elective month or two away. Reach out to people who you want to emulate or who you think could be a potential role model or mentor for you! And you’ll be surprised - I always respond with an email to any student or trainee, and if I just don’t have space I let them know, but we’ve taken many many student research interns over the years. It’s really about just putting yourself out there.

8. What are you working on most recently?

Well, we’re constantly working on our cohort of over 1,100 South Asians from the San Francisco Bay Area and the greater Chicago Area, MASALA - writing papers, disseminating our findings, and thinking of new ways to prevent diabetes as well as cardiovascular disease. The cohort is going to be 10 years old this year - it’s my number one biggest project.

The second new project is a Asian American research registry called CARE: we will be recruiting 10,000 Asian American community members in California who are interested in being in research that’s involved with aging, cognition, and dementia. These are Asian American groups with adults of any age, and I’m helping with the South Asian registration. The point of this registry is that when future researchers want to do research and include Asian Americans, they have a really rich registry of 10,000 names with different demographic characteristics, and all the barriers for getting better representation are lowered.

9. Where can we follow your work?

I’m on Twitter as @alka_kanaya; you can also follow the results of the MASALA cohort at @masala_study or at our website. Our website also has a great South Asian community health resources page with tips about how to stay healthy!