What got you interested in science and how did you pursue science as a career?
Probably as early as first grade I got the idea in my head that I was going to be a scientist and it never dawned on me that I should be anything else. I was sufficiently naive that when I was at Cornell as an undergraduate, I had no idea what a college of engineering was; I didn’t know what engineers did as a career option. I eventually figured it out by my third year because some friends went to an engineering school, and I feel like I would’ve enjoyed life if I would’ve become an engineer, but I didn’t consider alternative careers. That said, I now know, even if I was unaware of this before, that I get bored really easily. And so any job that requires doing the same thing over and over again, without constantly learning new things, wouldn’t have really worked well for me. And that applies to most jobs; there are not many jobs that have you doing different things. I may have gotten lucky, or perhaps natural selection led me along this path. You think an ER doctor would be constantly exciting, but you know because I did this in residency–after a few months of being in an ER doctor, you’ve seen broken bones, blood, and things. Whereas I’m constantly reinventing myself in science. The work I did in my Ph.D. thesis, well I don’t want to completely dismiss it, but it’s 20 years later, and it would be trivial today. Part of science is that what you’re doing now is going to be boring in ten years. A combination of naivety and natural selection, science is the only thing I could have chosen.
Do you have any advice for us as young adults just about to apply to college and interested in science?
If you’re really interested in undergraduate research, schools without graduate programs might also be worth considering. Places like Reed College. The other thing is, in a lot of institutions, if you are strong, good, interested, and committed, you can do great research as an undergraduate even if not all undergraduates have access to research opportunities.
Try to focus on the present and not the future. You might be better off doing parts or traveling in your undergraduate summer than doing research because you’re going to spend the rest of your life doing lab work anyways. All the paths work fine, there are a lot of ways forward in the research field.
What was your experience like at Cornell?
I put off my graduate school choice until my senior year of college. I thought I was going to get a Ph.D. only for a long time. I met someone in my junior year of college who was a senior, and he told me he wanted to get an MD-PhD, and I was like “That’s cool, it has five letters instead of only three.” I was that naive, I couldn’t let someone beat me with the number of letters, so that was my main reason for choosing an MD Ph.D. You rarely find people this honest.
The other thing, I had been a nerdy geek focused on education up through college, and at that point, I thought I should be thinking about other things. I wanted to live in Seattle, so I thought about UW for graduate school. One of the main values of going to college, especially a name brand college like MIT, Stanford, an Ivy League, even Reed, is networking. You want to be stimulated by your peers; go to a place where there’s a lot of smart people around you. I wanted to go to an Ivy League, I liked Cornell because it had the best food. Curiously, Cornell was a big institution which drew from a lot of places, which diluted out the population of really exciting, intellectual individuals. I had gone to a high school which had drawn together lots of intellectual, science-minded students, people who challenged me. This sometimes inhibits collaboration, but it really drove me to be the best I could be. At Cornell, I didn’t find a lot of that competitive challenge, I really had to drive myself. That said, Cornell was a big school and it had a lot of diversity in courses. That gave me choice to take really high-end courses, as well as courses in metalworking and wine taste. It offered a lot, and it was a good school. I think Cornell was ok for networking, but moving to Seattle, it didn’t help me as much as it would have if I went to school in New York. Stanford, MIT, Caltech might have been better for international networking. Pick something that fits you personally, socially, where you want to live, whether you want to travel abroad or do undergraduate research.
What was the MD-PhD program like? And why did you choose it? Would you do it again?
Hard to say, I think it has probably served me well in the sense that having both degrees has opened new doors and helped me occupy niches that very few people can occupy. One potential person who I might have taken a job from described people like me as “rarer than a hen’s tooth.” So if you can develop skills that are “rarer than a hen’s tooth” you’re going to be very employable, whether that’s a special graphic artist, machine learning, or a Ph.D., where you would be doing surgery or clinical work. It also can put you in an interesting place. I never intended to be in Alzheimer’s disease, but I am now. Because I like to do research and I have all kinds of computational and quantitative skills, but I also know how the medical world works so I can be at this interphase of taking systems biology and figuring out how to move it into the clinic and treat patients. Which wasn’t really my intention when I started out doing the MD Ph.D. It was mostly to become a better scientist and because it would have five letters. But because I have this skill and I’m able to move my career focus as ISB moved its scientific and strategic interests, And I find myself leading ISBs translational efforts and also Alzheimer’s disease, which is cool.
I guess that’s great career advice is to be opportunistic and flexible and it’s like any kind of strategy or battle plan, military thinking, you make a plan which is good until the first shot is fired and then you go with the flow. Like they say most people in college you pick a major, and 70% of freshmen change their majors after a year or two.
I guess that’s one of the great values of an MD Ph.D. is that it gives you a little more flexibility, and actually I’ve talked to a lot of people doing an MD PhDs and some of them picked it roughly for the same reason I did where ‘I couldn’t decide, so I did both.’ You’re supposed to say ‘Oh, I wanted to become a translational medical researcher’ or whatever. To actually do research, if you actually know what kind of research you want to do, you probably only want one degree. You can save yourself a lot of time.
So it took me nine years to go, and it took me five years for the Ph.D. That’s a chunk of time out of your life. You know, you’re middle-aged by the time you’re done. If you look at it from earning power you just lost a chunk of time, with a five-year delay as a doctor lets say. So your lifetime earnings are down about, you can do an exponential curve, a million dollars or something. But hopefully that’s not why you’re in it, but if it is, just go get the MD. For me, it was simply the case of doing it. At UW there’s no real synergy between the degree programs, you kind of just do both. Some institutions they really do try to have some synergy, so I don’t know whether its changed but back when I was going to school, Washington University sort of made sure that all its MD PhDs students did both degrees in a barrier of six years, so really short PhDs.
In your MD, did you do any work as a doctor or did you have patient contact at all? Did you like the patient contact?
Medical school involves clinical experience. Anyone who goes to medical school has done some surgery, has done some psychiatry, that’s what an MD is. In addition to that, I did one year of pure clinical work as an intern. After that, I came back to ISB and I’ve been here mostly ever since.
Well, as I alluded to, I love patient contact, it just gets boring. I mean I love being pulled out, I love interacting with them,
I love being a doctor, but I’m easily bored. So after you’ve treated a hundred people with hypertension, it’s not that I don’t like it, but its just so much more fun to invent some algorithm that no one has invented before, sequencing a genome, and changing the way we treat Alzheimer’s disease. But it’s not a judgment. If there wasn’t such thing as research, in some dystopian world where researchers were condemned by the president or something, and nobody was allowed to do research, I would be happy being a doctor. But this is more fun for me.
What advice would you give for picking a career?
Try them out, try internships, talk to people in professions you might be interested in.
Many doctors have to get up in the middle of the night. My circadian rhythm is sensitive, my body doesn’t function at 3 AM. And this is just something that is not on the radar for most people going to medical school. They don’t think about that. And so when I actually discovered that to do well as a doctor you had to do well at sleeping horrible hours, I decided that being a doctor wasn’t for me. Of course, I had kind of chosen not to do medicine as a career for research reasons, but if I had picked being a doctor, it would have been like “Crap, what do I do?!”
Experiences, internships, shadowing, talking to people are all great. I was working with one person who really wanted to be a veterinarian and studied this through college and discovered they had really bad allergies, and then she switched her career path to computational biology. These are all career changes to take careful consideration of that often aren’t thought through.
What is your research focused on at ISB?
Right now, ISB is transforming itself. Its historical existence is primarily a research institution and we’ve just recently completed this alliance with Providence St. Joseph Health, a hospital system. Increasingly we are trying to deliver our systems biology philosophy ideas into actual medical care. I’ve become very interested in Alzheimer’s disease, which is a very worldwide complex disorder. It’s not like a broken bone, a single thing happens, you fix it, you’re done. There’s a lot of things that cause Alzheimer’s, even within an individual who has it, and it’s not really clear how to treat it. We think that it requires multiple interventions– we don’t think we’re going to find a pill to treat Alzheimer’s disease; It might require changing your diet, exercise, cognitive exercise, special kinds of mental exercises, control of sleep patterns, glucose, maybe a pill. Each person will have a different combination of treatments, personalized to them. But we can’t personalize the treatment without understanding the system. We need all sorts of measurements to determine a treatment, to determine what’s going on with their blood, are they responding, or are they not. We’re calling these multimodal interventions. It isn’t new, but this kind of therapy is the exception rather than the rule. You think about triple therapy for HIV, using 3 different kinds of drugs. In retrospect, it makes a ton of sense, but at the time people said: “Oh my god, that’s wrong!” There’s a lot of complex treatments, like hypertension, diabetes, and we think that Alzheimer’s is a complex disorder. My job with a team of others is to come up with therapies and ways of personalizing multimodal therapies and our main job are to take those therapies in a clinical trial. But, I want to do this in a systems biology way where I understand why and if it works rather than just determining a solution based on phenotypic results. I can get a ton of measurements to use machine learning to understand not only which therapy works, but also why and how it worked. If I had done it traditionally without the measurements, I would say ‘oh it worked’ but with 36 different things I’m changing, which one do I add or subtract or tweak, and I just don’t understand what is happening. ISB strives to understand the systems. A lot of what we do in systems biology is collaborative, you’ve probably figured that out by now, and that’s something really cool about this institute and the science that we do. If you want to succeed in any field these days, understanding how to work in teams and collaborate is vital. If you have two expertise, math and biology, art and physics, you name it, you’re likely to be a really strong team member. Even if you’re not the best at both things, you’re the glue that holds the team together. I’m not the best doctor, the programmer, artificial intelligence, but I can be at the center of this team and be an effective team leader. I recommend either being the best at one thing or just being very good at two things.