This is the fifth in a series of interviews we are conducting with each of our first-year research assistants about their OrACORe experience so far.
Val Leifer began working as an OrACORe research assistant in the summer of 2019, after graduating from Harvard College with a Bachelor of Arts degree in Molecular and Cellular Biology with a minor in English. Outside of the classroom, she spent a summer at Cambridge University in England, where she did structural biology research on a human developmental protein in Professor Venkatraman Ramakrishnan’s laboratory; she continued this work at Harvard Medical School with Professor Alan Brown. In her free time, she enjoys running, reading, writing, and skiing and also leads a creative writing program, which she started this year, at FINEX house, where other OrACORe RAs also volunteer as part of a tutoring program.
1. What about this research position attracted you to it?
This position offered a terrific opportunity to engage with and understand health policy much more deeply than I had ever had the opportunity to do before.
As an undergrad, I studied molecular biology and biochemistry and performed research in structural biology (the study of the molecular structure of biological macromolecules, like proteins and nucleic acids). Over the course of my four years in college, I also realized that I wanted to go to medical school.
My molecular biology and biochemistry professors did a tremendous job of helping me understand the world, from the “bottom up”: from how chemical bonds form between atoms, to how those atoms form molecules, such as amino acids, to how those molecules come together to form macromolecules, such as proteins, which interact with one another in the metabolic and biochemical pathways that enable life in all forms, human anatomy, and in turn, molecular medicine.
Then, senior year, I took an incredible health care economics course with Professor David Cutler. The class opened my eyes to a new perspective on medicine and health care, which I think of as a “top-down” perspective. In this class, we discussed some of the greatest health care challenges the world faces today. These include questions of patient access to treatment, sky-high pharmaceutical costs, how to pay doctors, and whether certain services are even effective at all. I realized that it is essential to understand health care from both perspectives to provide patients with the best care possible. It also drove me to seek more exposure to this “top-down” perspective.
2. What’s a typical week on the job for you?
I work mostly on OAPol, our life-course Monte Carlo simulation of knee osteoarthritis (OA), which we use to answer questions about the cost-effectiveness of certain treatments and/or treatment combinations among different medical and demographic populations. Right now, I am working on a cost-effectiveness study of bariatric (weight-reduction) surgery among people with knee OA. This question is relevant because weighing more substantially increases a person’s risk of developing knee OA. If weight-loss surgery can delay the onset and progression of a person’s knee OA as well as confer additional health-related benefits, such as lower risks of heart disease and mortality at all ages, then it may be able to increase a person’s life expectancy while reducing lifetime medical costs. We are trying to quantify these benefits and determine the cost-effectiveness of the surgery among different populations and different treatment scenarios.
3. What do you like most about being a research assistant at OrACORe?
One of the things I like best about working at OrACORe is that it has made me appreciate the many perspectives from which it is possible to study a particular disease, from the quantitative to the qualitative, from the molecular to the economic, behavioral, and social. It’s great to shake up the nature of the work that I do and have a mix of projects going at any given time.
For example, in addition to the quantitative work I do on OAPol, I’m involved with two more clinically-focused research studies—KaRaT and SHieID, both of which also focus on knee OA. KaRaT aims to identify ways to increase physical activity among recipients of total knee replacement (TKR) surgery. SHieID is examining the use of prophylactic antibiotics to prevent joint infection among people who have had TKR.
4. What’s one thing you’ve learned in the past month here that either changed the way you understand health care or influenced you in some other way?
One thing that stands out is the way in which past treatment history can influence the efficacy of future treatments. For example, the success of total knee replacement, in terms of reducing knee pain, is lower among patients who have taken opioids prior to surgery than it is for those who have not. The studies that have shown this control for a person’s initial pain severity. The idea that a past treatment may reduce the efficacy of a current treatment, or that a current treatment may reduce the benefit of a future one made me realize how critical it is to consider patients’ past, present, and future medical histories when recommending a treatment.
5. What are your plans post-OrACORe?
After OrACORe, I plan to go to medical school. Before OrACORe, I knew that I wanted to be involved in research in medical school but was not sure about the area or type of research. I also didn’t have a clear picture of what non-wet-lab research entails. The past six months have not only opened my eyes to the importance of health policy and outcomes research but have also helped me realize how much I enjoy it as a quantitative and detailed-oriented, yet fast-paced and interdisciplinary, field of work. As the U.S. grapples with how to improve its health care system and as larger datasets about population health become available, the ability to work with those datasets to model health-related outcomes and assess whether certain treatments are worthwhile will become increasingly important. I am very grateful that OrACORe has given me the opportunity to perform research of this kind already and am excited to continue to do so in medical school and beyond.