Juicebox Podcast: Type 1 Diabetes

Episode #1658 – Dr. Michael Haller Returns

Host: Scott Benner
Guest: Dr. Michael Haller, Chief and Professor of Pediatric Endocrinology, University of Florida
Date: October 21, 2025

Episode Overview

This episode features a robust and candid conversation between Scott Benner and returning guest Dr. Michael Haller—a leading pediatric endocrinologist—diving deep into advances in type 1 diabetes (T1D) research, the realities of “the cure,” the critical need for early risk screening, and the challenges of getting meaningful innovations quickly to those who need them. Together, they confront myths and false hopes, discuss the industry's role and responsibility, and offer practical, actionable advice for families and clinicians navigating T1D.

Key Topics & Insights

1. Advances in T1D Treatments & The Elusive "Cure"

• Cell Therapy Timelines & Regulatory Hurdles ([04:55])

  • Scott opens with an anecdote from 11 years ago about “the pouch” for beta cell replacement. He recalls being told mass market cures could take “15 years” even if developed tomorrow.
  • Dr. Haller: “It’s hard to always predict what the regulatory pathway and timeline is going to look like... it’s not a trivial thing to build up the machinery to manufacture… these kinds of biomaterials.”
  • Progress is happening, but slow, even as timelines compress somewhat with more cell therapy options and potential FDA breakthrough status.

• Commercial Incentives vs. Scientific Progress ([06:06], [08:03])

  • The commercial side fears being outpaced by better, newer tech after investing billions, slowing some development.
  • Dr. Haller: “Scientists are iterative people... The notion of 'we're going to do it better at some point beyond'... doesn’t bother the scientific community... It’s more challenging on the commercial side.”
  • The market is more competitive and dynamic for tech like pumps and CGMs than for immunotherapies or cell-based ‘cures’, but Dr. Haller is optimistic that options and choice will grow in all areas.

2. False Hope vs. Realistic Optimism: Myths About “The Cure” ([15:57])

• Setting Realistic Expectations ([21:44], [23:49])

  • Scott and Dr. Haller discuss the cycles of hype and letdown around "the cure," including viral stories about mice cured of diabetes.
  • Dr. Haller: “I’m a big believer in having hope... but the thing that drives me nuts is false hope. There are a lot of people out there who, unfortunately, peddle it constantly... it’s like the whole notion of the decade of a cure... I’ll never give people a timeline... but I do think we’re every day making progress towards it.”
  • He points to the growing pace of discovery (“the pace is accelerating”), but repeatedly underscores that a real, safe, broadly available cure isn’t imminent.

• Debunking Pharma Conspiracy Theories

  • The hosts directly address the recurring suspicion that pharmaceutical companies suppress cures.
  • Dr. Haller: “If you really had a therapy, a biologic approach that was curative, you as a company could name your price... There are gene therapies... that cure awful diseases. They cost 3, 4, 5 million dollars a patient. Insurance companies are paying it because if they don’t, that patient’s going to cost them significantly more.”
  • Large companies like Sanofi and Lilly are simultaneously innovating in both insulin and immune-mediated treatments, showing there’s incentive for progress.

3. Importance of Early Screening for T1D ([27:25])

• Reducing DKA & Changing Diagnosis Stories

  • DKA (Diabetic Ketoacidosis) rates at T1D diagnosis are still unacceptably high (30-50% in the general community), but early antibody screening can virtually eliminate this ([27:25]).
  • Dr. Haller: “If we’re screening effectively and identifying people early and getting them enrolled in follow up... that DKA rate goes down to less than 1%.”
  • Early detection allows for gentle, safer transitions post-diagnosis, and more opportunity for enrollment in studies or preventive therapies.

• Screening Challenges: Family & Provider Inertia ([30:12], [30:54])

  • Many first-degree relatives remain unscreened, largely due to lack of awareness or provider knowledge.
  • Dr. Haller: “It’s just a failure of education... There’s this we call therapeutic inertia that exists until it becomes standard of care... We gotta start by educating, educating, educating, and get people to be aware.”

• Provider-Focused Educational Initiatives ([33:12])

  • Emphasis should be on educating providers rather than solely public campaigns.
  • Dr. Haller: “We’re... doing educational sessions, providing continuing medical education for providers, going to providers clinics to literally show them how to order antibodies and what their options are for doing it.”

• Making Screening Easy & Accessible ([40:29])

  • Success depends on minimizing barriers: point-of-care kits, telehealth early stage clinics, and clear follow-up pathways for families with positive screening.

4. Honest Critique of Industry Practices & Advocacy ([35:17], [36:37])

• Marketing Efforts Miss the Mark

  • Scott voices skepticism around industry marketing, noting campaigns frequently target the already-engaged ("the 1 percenters"), not underserved or highest-risk populations.
  • Dr. Haller: “The marketing for the 1 percenters is different than the folks who are... [at highest risk].”
  • Both agree more effort must target primary care providers and less-informed communities, not just established advocates.

• Real-World Impact Stories

  • Personal anecdotes of misdiagnosis and tragic delays highlight the urgent need for practical screening improvements.
  • Dr. Haller: "It's a common experience... there's 1 out of 15 or 20 that was seen by a handful of providers in the weeks prior to their diagnosis with symptoms and signs that should have been plainly obvious."

5. Technology, AI, and the Future of Medicine ([22:20], [48:52])

• “Pragmatic Hope” in Treatment and Research

  • Both urge living pragmatically—acting every day as if a cure won’t come in time, while still supporting and following new research.
  • Scott: “Day to day we act like it’s never going to happen... but I’m also not, not hopeful.”

• The Role of AI and Big Data in Medical Progress ([48:52])

  • AI can streamline diagnosis, expand differential thinking, and help personalize therapies.
  • Dr. Haller: “I’m bought into the use of AI... I have many times put symptom complexes or patient complaints in to see if it broadens my differential... I don’t think AI replaces doctors... but I don’t think there’ll be any doctors, successful ones, who don’t use AI.”

Notable Quotes & Memorable Moments

• On False Hope:
  “There are a lot of people out there who, unfortunately, peddle it constantly—loyal salesmen peddling misinformation. And all that does is serve to upset people further. It’s like the whole notion of the decade of a cure and just it’s right around the corner. I think that’s not being fair and transparent.”
  — Dr. Michael Haller ([23:49])

• On Pharma's Motivations:
  “If you really had a therapy... that was curative, you as a company could name your price... There are gene therapies on the market that cure awful diseases. They cost 3, 4, 5 million dollars a patient. Why? Because the return on that investment is well worth it.”
  — Dr. Haller ([15:57])

• On Screening Gaps:
  “There are tons of people living with type one whose first degree relatives are not being screened. And it’s really a shame that we’re not doing that because that’s not a research question anymore... it’s now something that should be standard of care.”
  — Dr. Haller ([27:25])

• On Progress:
  “It is sort of amazing when you step back... from an insulin at all to all these analog insulins and pumps and CGMs that were purely science fiction are now reality and they’re only going to get better.”
  — Dr. Haller ([21:44])

• On Hope vs. Pragmatism:
  “I live, hopefully. But we’re pragmatic. So day to day we act like it’s never going to happen... But I’m also not, not hopeful. And I do think all this stuff is incredibly interesting.”
  — Scott Benner ([22:20])

• On Use of AI in Medicine:
  “I don’t think AI will replace doctors... but I don’t think there’ll be any doctors, successful ones, who don’t use AI... you can either choose to adopt that technology... or you can become a dinosaur.”
  — Dr. Haller ([51:03])

Timestamps for Core Segments

• Early timeline discussion & translational hurdles: [04:55]–[08:03]
• Myth-busting: Pharma, cures, and economic realities: [15:57]–[19:31]
• Hope, false promises, “curing mice” vs. people: [21:44]–[26:49]
• Screening, DKA reduction, and provider inertia: [27:25]–[33:12]
• Marketing strategies and advocacy critique: [35:17]–[39:51]
• Practical guidance for families and providers: [40:29]–[46:03]
• AI and technology in T1D future: [48:52]–[51:12]

Practical Takeaways

• Cure is not imminent; be hopeful but pragmatic. Take proactive daily management actions, while keeping an eye on research progress.
• Early screening for T1D autoantibodies can drastically reduce DKA and save lives. Providers and advocates must push for this to become true standard of care.
• Educate providers, not just the public. Systemic change begins with those who order tests and provide initial guidance.
• Demand and embrace innovation—and keep realistic expectations. There are promising advances (cell therapy, immunomodulation, AI), but none are magic bullets yet.
• Push for better, smarter healthcare infrastructure, not just new technology. System-wide improvements will benefit more people than piecemeal fixes.

For further resources on T1D emotional health, technology, and early screening, visit JuiceboxPodcast.com.