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Harvard Epidemiologist Receives NIH Pioneer Award To Better Learn What Works  In Public Health

What do you do as a productive researcher after you have published nearly 550 papers and learned about multiple diseases? The answer, if you’re Harvard’s Donna Spiegelman, is you switch gears to become more actively involved in developing methods to better assure the use of what you and others learn from etiologic studies. Spiegelman is professor of epidemiologic methods at Harvard and a lead numbers and methods person behind the Nurses Health Studies, the Health Professionals Follow-up Study, and other research projects at Harvard. She will focus the later part of her career doing a better job of evaluating public health interventions.

Why The Switch?

Asked more specifically about why she felt a need to make this switch, Spiegelman told The Epidemiology Monitor it came from a desire “to make a difference, to have impact on public health.” She did not have to search far and wide to find examples of upstream research findings that could be having more downstream impact. She has been involved in global health and nutrition initiatives in multiple countries as well as in an HIV treatment project in Tanzania. In all these situations, she has been able to imagine how  interventions might be altered or evaluated more correctly to achieve greater impact. Now she will get her chance to act on these ideas.

Why The Award

The NIH Director’s Pioneer Award is a grant worth $2.5 million over 5 years which NIH says is for scientists of exceptional creativity who propose pioneering approaches to major challenges in biomedical and behavioral research. Asked why she thinks she won the award, Spiegelman told the Monitor she is an experienced researcher who had received multiple R01 grants from NIH which turned out to be productive. “NIH had invested in me,” she said, “and given that NIH has become interested in implementation science, mine was the right idea at the right time.”

Willingness To Change

An important criterion for the award according to Spiegelman is that investigators have to be willing to change the direction or focus of their research, and that is not something everyone is willing or able to do, she said. You have to be able to make a convincing case that you will in fact make a radical switch and not just make it seem like you will.

Unrestricted Award

The award she received has very few restrictions and in that sense is akin to the MacArthur Foundation’s Genius Awards where money is given to individuals to do as they see fit. In Spiegelman’s case, the award only requires that a progress report be made each year. Otherwise, there are no specific aims such as those in a regular R01 grant, and certainly no deliverables as would be required in a government contract. Spiegelman’s only constraint is staying committed to an overarching goal.

Unique Ideas

While implementation science is not a new field, Spiegelman’s proposal does have unique elements. She described these as the development of new methods to facilitate or improve the evaluation of the effectiveness or cost-effectiveness of interventions. She described stepped-wedge designs for interventions as an example of a methodologic area in need of fresh ideas and further work.

Another is in the area of calculating cost-effectiveness ratios where she said some of the simplifying assumptions used by investigators may not fit the data optimally. In one example from Tanzania, she described a reversal in a conclusion about the cost-effectiveness of a particular HIV intervention because investigators had underestimated mortality below age 18. “That makes a big difference in calculating life expectancy,” according to Spiegelman, “and the new estimate showed the HIV intervention to be cost-effective.” 

Products

Anticipated products from Spiegelman’s work are the development of a toolkit that might be used by analysts working for policy makers. Such a toolkit might include user friendly software or macros that might allow analysts to assess different scenarios for stepped-wedge designs or different approaches to calculating cost-effectiveness. Spiegelman already offers a long list of macros on her webpage at Harvard and she envisions the possibility of creating a second page of just implementation science software.

Other Elements of Implementation

Asked about other elements important for implementation of interventions such as feasibility or public values, Spiegelman acknowledged that these are also at play in policy making and must be integrated along with evidence to formulate policy. While she has not thought of these as much, she offered that perhaps questions of feasibility can sometimes be transformed into questions of costs since lack of resources is often a feasibility barrier to implementation. If so, these costs should also be factored in to the estimates of cost-effectiveness of different interventions.

She stated that questions about public values may be understood in the social sciences as questions about acceptability or compliance and may be examined as part of the field of dissemination research. She expects to call on such experts to help evaluate obstacles to the implementation of new programs at scale and in the development of a short course and other products anticipated to come from her grant.

Words For Colleagues

In closing comments to The Epidemiology Monitor, Spiegelman said she hopes other epidemiologists will think more broadly how the findings from etiologic research might be more effectively, broadly, widely, and rapidly translated. She is currently the exception among epidemiologists for winning the NIH Pioneer award and would like that to change. She believes that epidemiology is not even close to reaching the limits of what it can provide to improve public health. 

For more information go to:  http://tinyurl.com/nx72r7o 


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