Alika Maunakea, Hawaii's Doctor, Is In
WHY YOU SHOULD CARE
Because the best research saves lives.
By Libby Coleman
Honolulu’s many tourists arrive expecting mai tais, suntans and perhaps to, ah, get lei’d. Even in January, the temperature’s likely to be in the high 70s, so out-of-towners can surf alongside the locals. But Alika Maunakea has a very different view of Honolulu. Where vacationing mainlanders see coconuts, he sees diabetes. They see palm trees; he sees heart disease.
For him, this tropical island is a hot spot all right, one of health issues, particularly for island natives. Indeed, it may be one of Hawaii’s saddest secrets, born out of a poor economy and isolation from more-prominent medical care. But Maunakea is working to unravel those issues; already, the 36-year-old tenure-track assistant professor at the University of Hawaii’s John A. Burns School of Medicine has altered the understanding of diabetes treatment in native populations. By changing his diabetic patients’ diets, he showed that it took only 12 weeks for their health to improve. Wildest of all, he’s studying whether those people would be less likely to pass the disease on to potential children. Maunakea’s work is founded on a core, contrarian belief: Chronic diseases sprouted in native Hawaiians within “a short time frame,” he says, and relatively recently, due to factors like poverty. Which might not sound good, but to Maunakea, it does: It would mean the high rates of these diseases are reversible.
This lead him to blend modern studies with health-related ancestral knowledge.
Maunakea’s work has earned him nods from a variety of sources, including Honolulu Magazine and Hawaii Business Magazine as one of the state’s five most important doctors and as a Hawaiian to watch. With Hawaii lacking in medical resources, Maunakea might be its one-man revelation as the first epigeneticist to start a lab in the state. And it’s all after spending most of his life so far incubating as a student at top-notch programs at the University of California, San Francisco, and the National Institutes of Health. “That takes tremendous commitment. We need more people [like Maunakea] in visible situations who are successful and impacting the community,” says Jerris Hedges, dean of the John A. Burns School of Medicine.
Hawaii’s brain drain has been documented for more than a decade. A report by the Western Interstate Commission for Higher Education shows that 14 percent of 2005 high school graduates in Hawaii who went on to an associate degree or higher resided in another state by 2010, more than twice the proportion in Washington State. For Maunakea, it was a long flight back to Hawaii from the National Institutes of Health in Maryland, where he completed his postdoc. “There aren’t many researchers that have native Hawaiian heritage at the level that Alika’s at,” says pediatric neurologist Ryan Lee. “He has a personal voice that can speak to a lot of the native Hawaiian needs.”
Hawaii’s poor health record may be the biggest reason for Maunakea’s return. Like an ignored stepchild, the 50th state, which geographically is as far from the West Coast as Paris is from Dakar, has long been plagued with some of the worst health statistics in the U.S. And a lot of that has to do with native Hawaiians experiencing higher risks for fatal diseases: Native Hawaiians’ heart disease mortality rate is 68 percent higher than the rest of the state’s population and 130 percent higher for diabetes, according to a study from 2004.
Even though the native Hawaiian population is increasing in Hawaii (one estimate more than doubles the population, to nearly 700,000, between 2015 to 2060), their health concerns aren’t studied at many health centers. Maunakea calls the issue “underfunded,” though maybe less so in recent months — in July, Hawaii’s congressional delegation announced more than $10.5 million in funding for native Hawaiian health care centers and projects. “The funds allocated through these grants will help our health centers to better serve our native Hawaiian community, which still faces many critical health issues,” Rep. Mark Takai wrote in a press release.
The day we Skyped with Maunakea — a chat full of seven-syllable phrases like “DNA methylation” — we caught him at his Honolulu office. His alternative health education started early, while he was growing up in Waianae, in Honolulu County. When his throat was sore, his great-grandmother didn’t head to the pharmacy for anti-inflammatory medication; instead, she headed to the garden. In high school, Maunakea studied his grandmother’s remedy and found the properties of the plant she had used were similar to those of drugstore antibiotics. (One of his high school science projects examined the effects of a Hawaiian plant on cancer cells.) This led him to blend modern studies with health-related ancestral knowledge. “Epigenetics spoke to my own upbringing,” he says. “The perspective of my great-grandmother was that the environment plays a large role on our lifestyle and our health.”
It will take time for Maunakea’s work to yield results. Lee thinks it might be around five years before Maunakea will know if there’s a test for diagnosing autism and predicting whether an autistic patient will respond to different therapies. Then there will be time needed for approvals and more phases of testing. The work would be “a first step,” Lee says, but not definitive.
The solutions are simple, Maunakea says: “It’s really about healthy eating, nutrition, behavior, stress management. Everything really does effect your health — as scientists we’re realizing that more and more.”