Mahima Kumara began working as an OrACORe research assistant in the summer of 2021 after…
Morgan H. Jones, MD, MPH (MHJ) is an orthopaedic surgeon at Brigham and Women’s Hospital. Dr. Jones was previously involved in the MeTeOR and TeMPO studies at our Cleveland Clinic site. We are excited to welcome him to Boston and to the OrACORe team where he is the Principal Investigator of CoMeT (Corticosteroid Meniscectomy Randomized Trial). Dr. Jones talked with Research Assistant Maame Opare-Addo (MOA) about his outlook on the research process, finding balance between his clinical and research pursuits, and his goals for the future.
MOA: I’m interested in learning more about your dual MD and MPH degrees. How would you say your MPH informs your role as a clinician and researcher?
MHJ: My interest in obtaining an MPH began during medical school when one of my friends decided to pursue an MPH immediately after medical school. I was intrigued by the idea, but I progressed directly to residency and figured that the opportunity to do an MPH had passed me by. Then one of my mentors in fellowship—Brian Wolf—encouraged me to pursue it. The reasons for this were numerous, but in medical school, I only received a brief crash course on epidemiology and biostatistics. He pointed out that if I wanted to perform meaningful research, then I would need further expertise. What’s great about the MPH is that it also covered topics such as global health and the social determinants of health. I took additional electives that gave me a better perspective on the intersections between healthcare and society.
The added benefit that resulted from pursuing an MPH was picking a faculty mentor. I met mine, Dr. Jeff Katz (OrACORe Center Director), after leafing through a book of doctors with similar research interests as mine. After a 15-minute meet-and-greet with Jeff, I realized we were a great match. It’s fitting this occurred right before the MeTeOR project started because it allowed us to start collaborating almost immediately. Having Jeff as a mentor has been great for helping me formulate meaningful research questions and getting great advice about my career and life.
MOA: You’ve been a part of the OrACORe fabric as a co-investigator and an enrolling surgeon from the onset of the MeTeOR study over 12 years ago. We’re glad to have you back as the principal investigator of CoMeT. What sparked your interest in CoMeT and what do you want people to know about your research?
MHJ: I’ve always been interested in the arthroscopic partial meniscectomy (APM) and patients who undergo this surgery because it’s both a common and a controversial procedure. Arthroscopy was performed at high rates in the 1990s, but in the early 2000s, a paper by Bruce Moseley and colleagues at the Houston VA showed that patients with a primary diagnosis of osteoarthritis (OA) did not benefit from arthroscopy, and another paper by Sandy Kirkley and colleagues at the University of Western Ontario confirmed these findings in a non-veteran population. My team and I are curious to know what kinds of people, or subgroups of patients, benefit from this surgery and how we can help them achieve a good outcome. Similarly, we’re interested in understanding more about the patients for whom an APM would not be recommended because of the potential for OA progression.
CoMeT stands for Corticosteroid Meniscectomy Trial. My colleagues and I in Cleveland started planning the trial between 2018 and 2019, and we recently started enrolling and randomizing participants. It’s a double-blinded placebo-controlled randomized trial focused on synovitis in patients undergoing APM. Our team hypothesizes that people who have more severe inflammation in the synovium also report higher pain levels, and therefore take longer to recover. This perioperative inflammation is currently not addressed at the time of surgery but may be treated with intraarticular injection after surgery in patients who have a persistent effusion. If we can better characterize the levels of inflammation they experience, it is possible that we can find a better way to treat it. For this trial, we are going to test whether injection of a long-acting corticosteroid delivered at the end of APM and before putting on the surgical dressing will improve recovery and lessen the progression of osteoarthritis. We’re also going to sequence RNA from synovial tissue and collect fluid, blood, and urine samples to evaluate biomarkers associated with inflammation. I’m very excited to be spearheading this effort! It’ll give us the information we need to learn more about inflammation after APM.
If we can better characterize the levels of [synovial] inflammation [patients] experience, we might find a better way to treat it.Morgan H. Jones, MD, MPH on CoMeT
MOA: Research can be a long yet rewarding process. It can appear like the focus of research is on making a conclusion and sharing it with the public. However, the journey towards that endpoint seems just as engaging. What about the research process, from start to end, stands out to you and why?
MHJ: A lot of learning occurs on the fly, and I often know more at the end of the process than at the beginning, but not just in terms of the results. For example, with TeMPO, I spent more time talking with patients about their concerns in a way that’s less algorithmic than in the clinic, which is an experience I found to be very helpful. I also appreciate the newness of the process because it gives me the opportunity to collaborate with people I haven’t worked with before.
I appreciate the newness of the process, especially since it gives me the opportunity to collaborate with people I haven’t worked with before.Morgan H. Jones, MD, MPH on the research process
Research oftentimes involves the reality of potentially needing to change the way I care for patients. It also gives me the opportunity to share our findings with them. This level of flexibility in approach and transparency enables me to provide my patients with accurate information about the pros and cons in the decision-making process regarding treatment options. Here’s an example with MeTeOR: we found that many people can experience a reduction in pain with physical therapy for a meniscus tear, but if they don’t improve and they opt for surgery (APM), then we are very confident that their pain levels will diminish post-operatively. It turns out that there are very few downsides for a patient to try non-operative therapy, such as physical therapy, before electing for surgery for a meniscal tear. With the MOON ACL study, we developed an individualized risk calculator that determined the best kind of graft to choose to help the patient avoid another ACL injury. The risk calculator also motivates patients to continue engaging in physical therapy to achieve a better outcome.
The frustrating aspect about results that are contrary to current practice patterns is that it’s hard for other medical personnel to adjust their outlook according to new information. It’s oftentimes easier to change your own approach when you’ve collaborated on the research team for years, but it’s different for someone who’s in practice and who hasn’t been directly involved with the research, perhaps only hearing about our conclusions in a brief talk.
MOA: How do you find a balance between your clinical and academic work?
MHJ: The hardest thing for people juggling both clinical and academic work is the pressure to do more clinical work. Administratively, the time allocated for research is called “protected time” because there must be somebody who’s your champion, someone who protects and values this non-clinical time so that you’re not held accountable for seeing fewer patients than your full-time clinical colleagues. Some people can balance both aspects by working nights and weekends, but this approach is difficult because research is such a collaborative effort, and you can’t expect other team members to be available during these after-hour times. Given time constraints and the importance of work-life balance, the key for me is to have protected time that I can dedicate to my research. Having longer-term goals also helps keep me on track and organized so that I make progress. I try to remain focused because there isn’t always a lot of time.
MOA: Congratulations on your move from Ohio to Massachusetts to continue your orthopedic practice at the Brigham! What are you most looking forward to here at work but also generally in MA?
MHJ: At work, I’m looking forward to collaborating with my colleagues. I’m particularly excited to be close to the OrACORe team. I’ve been with OrACORe for years from afar, but now I’m here and can learn more about conducting impactful research. I’m also looking forward to collaborating with my Brigham clinical partners and actively participating in the growth of the BWH sports medicine department.
Outside of the clinic, I’ve been enjoying Boston with my family. We love it here! Culturally, ethnically, and historically it’s a diverse city and that’s what we like about living here. While we appreciated living in the suburbs, Boston also allows us to explore and visit new areas. We can easily go outside to take advantage of all the fun activities the city has to offer. For example, my family and I recently visited the Louisa May Alcott museum and had a great time!
MOA: As an orthopedic surgeon, sports medicine physician, and researcher, there’s a lot to look forward to in your work! Where do you see your career going in the future?
MHJ: I like to categorize my work and career into different domains. There’s the clinical domain, where I’m taking care of patients, and the research domain. Regarding my clinical practice, I want to have a busy practice with the goal of helping as many people as possible, especially those with arthritis who are struggling to stay active. Many of my patients have newly developed or diagnosed arthritis, and I want to help them learn how to continue to stay active and healthy.
Many patients have newly developed or diagnosed arthritis, and I want to help them learn how to continue to stay active and healthy.Morgan H. Jones, MD, MPH on his career goals
Athletes are also a part of my patient population. With athletes, I want to help them return to playing their sports safely post-injury. The Brigham has a sports medicine coverage team that provides medical coverage of athletic events like football games and treats injured athletes while on the field. Brigham Sports Medicine is now covering sporting events at Boston Public schools (BPS)—we conduct pre-participation physicals and sideline coverage for many of the BPS football games. These sports physicals and sideline episodes could be one of the only interactions with healthcare professionals that some students may have, so we’ll connect them with the health care system if they need to be seen elsewhere.
From a research standpoint, I want to successfully complete CoMeT and continue to focus on designing future studies using this trial as a springboard.