Chapter 07: Research Focus Expands to Risks and Outcomes of Care

Chapter 07: Research Focus Expands to Risks and Outcomes of Care

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Description

Dr. Elting begins this chapter by explaining that the threat of infections was decreasing and so she expanded her research focus to supportive care. She transferred to the Department of General Internal Medicine (GIM) and worked with the Ambulatory Treatment Center.

Dr. Elting notes that she was advised to begin working independently of Dr. Gerald Bodey, as many professionals attributed her research to him because of their long working relationship.

Dr. Elting explains that in GIM she conducted research on nausea and vomiting. She also developed an interest in effectiveness, efficiency, and cost and conducted time/motion studies and studies to demonstrate the effectiveness of expensive drugs that insurance companies were unwilling to cover. She began to study economics.

She then makes observations about her own learning and mentoring styles.

Dr. Elting discusses the first study she conducted independently of Dr. Gerald Bodey: a study of the frequency and outcomes of thrombocytopenia (low platelet count) and the cost/benefits of transfusion versus drugs to treat the condition. This study brought her recognition and established her as the primary researcher in the field of risk and the outcome of care.

Identifier

EltingL_01_20150219_C07

Publication Date

3-5-2015

City

Houston, Texas

Topics Covered

The Interview Subject's Story - The Researcher; The Researcher; Professional Path; Mentoring; Discovery and Success

Transcript

Tacey A. Rosolowski, PhD:

So how did your research evolve next? Because there are a number of areas, different areas— Linda Elting, PhD, MPH Yeah.

Tacey A. Rosolowski, PhD:

—that you’ve done research in. Linda Elting, PhD, MPH Yeah. So I decided I wanted to do something in addition to infections, because to be honest, we were having fewer of them; we did a good job in developing new antibiotics. And because the chemotherapy regimens were more effective, we were having fewer and fewer deaths from infections. But the chemo regimens that were being developed were really toxic in terms of nausea and vomiting and some other problems, and so I wanted to expand to some other supportive care areas. So I transferred to the Department of General Internal Medicine. They managed the Ambulatory Treatment Center, where all the chemo was given. And there was an opportunity to work there, to be more independent. Many people told me I needed to get out of infectious diseases, because what I did was assumed to be Dr. Bodey’s work by many people on the outside, and that I needed to get out and be independent of him, because I had worked with him for, I don’t know, seventeen years, or something. And we were considered a unit. (laughs)

Tacey A. Rosolowski, PhD:

Right. Linda Elting, PhD, MPH So that, plus the need to branch out a bit and do some other things, I moved to General Internal Medicine and started working on nausea and vomiting and some other things, and at that point got very interested in effectiveness and efficiency in care and in cost, because we had some really cheap anti-nausea medicines that worked Okay, but the expensive ones were more effective, and they didn’t leave you with a patient who was sound asleep in the clinic bed all day long taking up the bed when someone else could have used it.

Tacey A. Rosolowski, PhD:

Mm-hmm. Linda Elting, PhD, MPH So we started doing some studies of—time and motion studies, how to effectively treat patients and get them home, how to do things on an outpatient basis, and how to look at the cost of treatment. There were insurers who were balking at paying for the expensive new drugs, but they were so much better than the old ones, that they were so much better for the patients and their families and everything else. So we started working a lot to look at not just the efficacy, but the value of the treatment. So that really captured my imagination. I started studying economic some to begin to look at those sorts of things.

Tacey A. Rosolowski, PhD:

So I’m getting the impression that when you need to know something, you just kind of say, “Okay, fine, I’ll go learn that.” Linda Elting, PhD, MPH Yeah. Actually when I was doing my doctoral work, because the place was really—the school was really open, and I didn’t have a set number of courses, it was hard to tell how close I was to being finished. And I can remember going in and sitting down with my advisor one day when I was supposed to be signing up for classes and telling him that I didn’t really want to go to any more classes because they slowed me down, I learned faster alone, it was a waste of time to go to a lot of the classes, and how much more did he want me to do? He said, “Well, if that’s the case, you’re finished.” (laughs) He says, “If you can learn faster on your own than you learn here, then you’re ready to be graduated.”

Tacey A. Rosolowski, PhD:

Oh, that’s very cool! Linda Elting, PhD, MPH He says, “It’s time for you to do your dissertation.” He says, “Let me know when you’re ready.” “Okay.” (laughter) And that’s my mark now for when students are ready to finish. You know, if they can learn what they need to learn to do the research that interests them, they’re ready to be finished and go do it. Getting money is not the mark of independence. Being able to frame a good question is the mark of independence, and know how to get the answers. Once you can do that, the money will fall into place. Somehow. Most times. (laughter)

Tacey A. Rosolowski, PhD:

That’s the laugh of a person who recognizes realities. Linda Elting, PhD, MPH Oh, yeah. Not all times, but sometimes. In those situations, it’s good to have lots of questions.

Tacey A. Rosolowski, PhD:

Yes. Yes. Linda Elting, PhD, MPH Some of them will pan out.

Tacey A. Rosolowski, PhD:

Some of them will pan out, yes. Well, we have about five minutes left, until 3:00. Linda Elting, PhD, MPH Mm-hmm.

Tacey A. Rosolowski, PhD:

Would you—I’d like it if you would take me through maybe one of those studies that you worked on in General Internal Medicine, whichever one you feel kind of had the most impact, either in its sort of significance of data or for yourself in terms of advancing your own research. Or, is there a better question for me to ask? Linda Elting, PhD, MPH Well, I guess a really big one for me when I was in General Internal Medicine was a study that I designed and initiated to look at the frequency and the outcomes in cost of thrombocytopenia, which is low platelets. And there were a lot of new drugs that were being developed at that point to increase the platelet count. There was a hope that that would be really effective. But we knew they would be very expensive drugs. But nobody had any idea how much it really cost to have low platelets, how frequent bleeding was, how often it was that you couldn’t just give a transfusion and have it work. And that was, I guess, the first really big study I did as a principal investigator separate from Dr. Bodey; it wasn’t in his area. And I got—was fortunate enough to get a drug company interested in it, so they funded the whole thing. And I was very blessed as a junior person that I was that Bob Benjamin [Robert Benjamin, MD; oral history interview], who was a very senior member of the faculty, agreed to work with me on that, even though he had known me for many years as a research nurse. He agreed to work with me on that, which gained credibility for my project with other departments around, and they agreed to participate. And so that brought in enough money for me to hire somebody to help with the work, I didn’t have to do it all myself. And it gave me an in with a company, and I learned how to deal with sponsors myself as a principal investigator. I had the opportunity, because it ended up being the only study that had been done on that topic, I ended up testifying before an FDA [Food and Drug Administration] committee for the—when they were considering licensing some of these drugs and approving them. And that was another—you know, a high-profile thing to do that established me as in the field. It gave me an in at some organizations, professional organizations, because it was an area that was attributed to me, that it was my thing. It wasn’t more work, or more independent than work I had done when I was in Dr. Bodey’s department. But it was viewed differently from outside. And so that was a really important project for me. It gave me the money I needed to hang on for a while, and it allowed me to establish my independence and my own reputation, which was important. So I think I would name that—there were some other things that may have been more scientifically important, but that put me on the map as the person who does the risk and outcomes and cost studies in supportive care. And from there, I went on to studies in oral mucositis and diarrhea and all kinds of different things. That one study kind of meant, I’m not just infections, you know? I do these other things, and it sort of emphasized to everybody that it was not the infection part that I did, it was the risk and outcomes in that other piece. And that gave me a really good kick-start to do that, and bought me enough time to get an ACS grant approved in febrile neutropenia. So then I was in pretty good shape.

Tacey A. Rosolowski, PhD:

Well, we’re almost out of time, so why don’t we leave it there for today? Linda Elting, PhD, MPH Okay.

Tacey A. Rosolowski, PhD:

That’s a good, like, closing off the chapter, you know? Linda Elting, PhD, MPH (laughing) Okay.

Tacey A. Rosolowski, PhD:

With promise of things to come. Linda Elting, PhD, MPH Okay.

Tacey A. Rosolowski, PhD:

So thank you very much for your time today, Dr. Elting. Linda Elting, PhD, MPH Sure. My pleasure.

Tacey A. Rosolowski, PhD:

And I am turning off the recorder at about two minutes of three. Linda Elting, PhD, MPH Okay.

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Chapter 07: Research Focus Expands to Risks and Outcomes of Care

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