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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