Niteesh Choudhry, MD, PhD, is executive director of the Center for Healthcare Delivery Sciences and an associate physician at Brigham and Women’s Hospital. He is a professor of medicine at Harvard Medical School and associate director of our Postgraduate Education program.
As associate director of Harvard Catalyst’s Postgraduate Education program, what do you find most valuable about what we offer to researchers?
The Postgraduate Education program has a vision of ensuring that researchers have both the skills and knowledge they need to be successful. What I think is most compelling are two things.
One is the opportunity for investigators to really see across the spectrum of research.
The courses that I direct are at the end of the translational research spectrum, which is referred to as T3 or T4 research. This is the stage where we learn whether a treatment or an intervention is safe and effective for use, and we want to figure out how it works in populations and how to scale it to global health.
In those courses, we often have people who are bench scientists, those who are on the pre-human side of the equation, because they want to learn about the translational spectrum. For me, exploring that continuum and allowing researchers to understand and study it is really quite compelling.
The second is that there are facts and so much information researchers need to learn, but in order to be successful, there also are cross-cutting competencies they need to know. These include how to manage projects, as well as to lead, mentor, communicate, and write effectively.
It’s these things, which may seem trivial or not quite hard science such as learning biostatistics, which are probably the biggest predictors of success for most researchers. If you look at people who have developed successful research careers–whether they’re bench scientists or clinically-oriented researchers–there’s a commonality in how they operate. Our program offers, in addition to the empirical, these cross-cutting competencies, which is really unique.
What are, in your opinion, essential courses or training programs that each aspiring clinical & translational researcher should consider taking at Harvard Catalyst?
Ironically, they’re the courses that I never had the opportunity to take myself. I wish I had learned some of the content taught in our courses when I was starting out.
“The Postgraduate Education program has a vision of ensuring that researchers have both the skills and the knowledge they need to be successful.”
For example, take our course Effectively Communicating Research. You can be a brilliant researcher–and there are many in our community–but the research isn’t useful to anybody if the lay public and especially funders don’t understand it.
You also have to think about the audience. Sometimes you want a lay audience to understand what you’re talking about, and sometimes you want to articulate your ideas to your peers. If the target audience doesn’t understand your argument, if they don’t understand your results, then nobody will. So, learning how to effectively communicate research is critical.
I would have liked to have taken our mentoring courses, such as Maximizing Mentee-Mentor Relationships. I had very good mentors, but many people don’t have that opportunity. The skills taught in our many mentoring courses are perhaps the most valuable of all our courses, in my opinion.
Your research focuses on adherence or non-adherence to medications and how this impacts cost. What are some reasons why patients don’t take their medications as prescribed?
I think of non-adherence as almost normal human behavior, which sounds ridiculous, but it’s true. If you think about adherence as a family of problems (exercise, diet, taking medications) and if we look at what happens in society, only about 50% of people take their medications as prescribed.
There are many reasons for these behaviors. Sometimes in the case of medications, there are side effects that patients experience which may make taking medication undesirable. Sometimes drugs are too expensive.
Even if you may not be of low socioeconomic status, it’s still the idea of paying for a medication, especially when you don’t perceive any benefit from it right away. Most medications are intended for lifelong use which means you don’t feel better right away. You don’t wake up every morning and say, “Thank God I didn’t die today.” Instead, you say, “Oh, I’m nauseous,” or “I have this ache,” which may be a known side effect of the medication. In that context, perceptions of illness are a major driver of non-adherence.
“Only about 50% of people take their medications as prescribed.”
I think what’s even more important is that it’s seldom one thing that stops patients from taking their medications; there are usually an interaction of factors. For example, if I don’t believe that a medication works for me, or if my physician didn’t explain to me the importance of a medication, then I think it’s not really that necessary for me.
What makes taking medicine as prescribed even more complicated is that we all have multiple competing reasons that change over time. For example, my colleagues and I have done research about what happens after major or stressful life events.
As you might imagine, people stop taking medications. As we think about this problem, we have to understand it in the broader context that we live, and the fact that there’s a variety of human factors which get in the way of doing what we would otherwise do.
How has COVID-19 and working from home affected your research?
It’s been affected in a lot of ways. I’m a hospitalist, which means about a quarter of my time is in the hospital and on the wards. Going into the hospital while also caring for my two young children that my wife and I juggle is a constant activity.
In the case of research, I’m a dry lab researcher. I run large trials and often do that with distributed healthcare systems around the country. As the surge was coming, research activities in many places, very justifiably, shut down and all of the institutions’ resources were directed to COVID-related activities.
A number of trials I was working on were in startup phase with a great deal of planning, so we shifted and those trials then became the predominant force. I did also get the opportunity to catch up on writing papers and taking on other projects using existing data. Our team was still quite busy; there was just a shift in the nature of the activities.
You wear many hats, you’re involved in various organizations, as well as teach, mentor, and conduct research. What do you like to do in your free time?
For me, my guilty pleasure is something that’s actually good for me, which is exercise. Exercise is a habitual thing for me. If I can find 45 minutes or an hour to exercise a day, then that, to me, is resetting. My reasoning is that I have the opportunity of not having to commute to the office every day, which admittedly for me is only 15 minutes, but I get back an hour of a day.
Apart from that, my kids are young and this is a remarkable time. In the era of COVID, this is a time for us to actually spend together. We go hiking in the conservation at the end of our street. We’ve lived in this area for almost 10 years and had been in the conservation twice before. Now, it’s became a normal activity we do.
While there are such horrendous things that are happening right now in life, I personally feel very blessed that there are many positive things too. I feel lucky that we have the resources that we need to keep our children safe and healthy.
See YouTube video above for interview highlights.