Hello, and welcome back to so you got to lifesite degree. Where are your hosts for Rita and Lisa to lifestyle undergrad students trying to navigate our future careers. This is Episode 10. And we're talking to Dr. Nisha Almeida about her role as a research scientist at McGill University's health technology assessment unit. How are you doing today, Lisa? I'm doing well just hoping for exams to be over soon on. On a more positive note. I have recently finished ish my ta position I finished all my marking for this semester, I put in all their little grades into little Excel document. presentation and report marks. So yeah, that's all that's all done. Like. It's like the end of an era. Yeah. Also, the other day, when I was just in my room studying, I look up and lo and behold, there's another squirrel on my roof. And this time he is closer than the one last time was. But he also stayed for less long, so I didn't. So again, like I tried to get a photo, but he scampered off really fast. What are you going to try to do on your roof? Do you have no idea? What What are you trying to do? Like? Are they looking for nesting? I don't think squirrels nest in the winter. Like honestly, if I could find a way to attract squirrels to like the underside of my window. I would definitely do it. Like a perch or something. Oh, my goodness. I bet if I put nuts there.
I bet you.
Yeah. How are you doing? I'm doing pretty good. I finished my exams super early this semester. Not to rub it in your face. But you know, it's been pretty great. So I find an i right now have been binge watching Avatar The Last Airbender. And it's so good. We just finished it is that is your first time watching it. It is Yeah, yeah, that's like, that's for sure. I've never seen it. I just I don't know, I feel like it's too late now. It's really not, I think you would still like it. There's some things that I come across that I can't believe and no one's told me this thing existed before. And people are just living their lives like having consumed this piece of content. This is like how I felt about when I read Harry Potter. And I was like, walking around having read Harry Potter and just living your lives. Like what is your definition of no one having told you about something? Okay, it's not that they haven't told me it's more like they've had this experience and are not constantly talking about. Like, like how magic wand in French is but gets mushy. very offended that everyone who knew that has not told me. I did tell you? Well, yeah, you not everyone. Yeah. Are you ready to talk to Nisha today? Super, super ready. Let's get into it. Nisha is an epidemiologist and head of the health technology assessment unit of the McGill University Health Centre. She works to assist hospital administration in evaluating the value of new health technologies and interventions using the best available scientific evidence, followed by a Master's and PhD in epidemiology and biostatistics at McGill University. Thank you for joining us today. Nisha, thank you. Welcome. Thank you for having me. So the first question we wanted to ask you is if you could tell us a little bit about what your job is.
So I work at the health technology assessment unit of the hospitals at the McGill University Health Centre. And just to give you a preamble on what health technology assessment units are, they're actually a fairly recent development. So they've really gained in importance over the past two decades. And this is because unlike medications for which we have very strong government regulatory bodies that hold drug companies to a very high standard for safety and efficacy, we don't have that for medical devices. And that would mean that our healthcare institutions would be inundated with expensive health technologies that don't necessarily work. And given our healthcare setting, which are often resource strained, we have to ensure that the devices that the hospital invests in are both safe and effective. So that's the role of our health technology assessment unit. And the existed many levels exist at the provincial level, the national level, or the hospital level, which is what we are, we are a hospital based high technology assessment unit. And so our role is to advise the hospital administration on integrating these new devices, but they don't necessarily have to be devices. They can be health interventions and have policies, and we evaluate how feasible they are for the hospital. But sounds super exciting.
So can you give us some examples of projects that you've worked on in the past?
Yep. So our unit is involved in two types of services, if you will. The first one is to perform a health technology assessment. So now that's where The hospital administration or a clinician comes to us and says, Hey, you know, I've heard about this robotic surgery, and we'd really be really interested in it. And so can you evaluate it? And so usually they just come to us and say, evaluate this thing. And because it's actually a scientific question, you know, as much as a policy question, we have to frame the research question. And that's what is our first step? So as an epidemiologist, that's my first step is to say, Okay, what exactly is our research question? What is your population? What is that intervention that you're looking at? So often seats, you know, your device that you wanted a cat, but then we often have to compare it to something, right? Because we want to know, well, how does this compare to the alternatives that exist already? If they do exist? The most important thing is the outcome, what exactly are we looking to improve with this new device? So that's our, you know, that's a health technology assessment, we start looking at the literature to see what is out there in terms of safety, effectiveness, you know, patient reported outcomes for that particular device. And then we write the report. And the reports really meant to lead to as a policy recommendation. So if the evidence is really strong in favour of safety and effectiveness, then you know, we have a committee, a policy committee who comes together and they debate what's in the report. And, you know, I mentioned, safety and effectiveness and cost, those are the big three. But over the past few years, people have been thinking that those are the only decision criteria that go into deciding whether a device should be integrated or should be adopted. And so that's another thing that we've been looking at our unit is to see, what are all these decision criteria that go into making a recommendation, a policy recommendation? And how do we translate? You know, what is one way to say, Yes, I can translate scientific evidence into policy, if it's effective, if it's safe. And if it's, you know, not too expensive, then it should be a yes. But those aren't the only criteria. There are patient reported outcomes. There's feasibility can do we have the infrastructure? Do we have the expertise at a hospital to run this device? What about ethical issues? What about legal issues? What about all of the various strategic considerations? You know, is there undue pressure coming from certain stakeholders? So there's this whole mishmash of decision criteria that goes into the final decision making process? So it isn't as straightforward as just doing the assessment and saying, yep, those three checks, boxes have been checked. So this device should be accepted in the hospital. So that's one of our services is how technology assessment. But we also do hospital quality improvement initiatives. Now, this is where a clinical team will come to us. Because they say, hey, we've identified this aspect of healthcare delivery, that could be improved. But you know, they know that there's something that can be changed, but they need our help. So our team, you know, consists of epidemiologists, and biostatisticians. And they come to us and they say, Hey, can you help us frame this research question, help us identify the ideal interventions that could bring about this change that they'd like to see? And could you help us identify the outcome if you want to measure and of course, we also help with performing all of the various data analyses to interpret the results that we see. So those are the two types of services we provide. And I mean, I can give you specific examples if you want, but I'll wait for questions from you.
Yeah, sure. I think it would be really nice to hear like how you've gone through this process for a specific project if you were able to do that. Sure. So
in terms of a high technology assessment, one of our recent ones was looking at a hydrogen spacer. So that's basically a gel that's injected between the prostate and the rectum of prostate cancer patients undergoing radiotherapy. So that the idea is that if you increase the space between the prostate and then the adjoining organs, were going to spare these organ organs, unnecessary radiation and has reduced toxicity. So that's, you know, a realistic sounding hypothesis. And this was brought to us by the radiation oncologists to see could be pleased about with this device. And when we looked at the literature, we found that you know, there was really only one study with one clinical trial, and the evidence was very good. Every week, and you know, and we also then looked at the budget impact, because that's very important for us to see, okay, if it's not terribly effective, and it seems to be safe, but in terms of the budget, it may actually be quite disruptive to our hospital. So we wrote the report. And then we have to weigh the pros and cons of all of these different decision criteria. And in the end, you know, the policy committee looked at the evidence, and they said that it was just far too weak to recommend it should be integrated at the hospital. So that was a health technology assessment. And a hospital quality improvement initiative is actually far more all encompassing. I have technology assessment, we usually just look at the literature to see what's been what's been written. If we have local data, that's also great, because then we look at what the hospital has been doing. But often, if it's a new device, the hospital doesn't have it, right. So we don't have local data. But a hospital quality improvement initiative, these are oftentimes more nebulous, but also very, very vast. And so to give you an example, we were approached by the hospital administration, because they noticed that patients at end of life were receiving very aggressive treatment. And so they're receiving chemotherapy, for example, in the few days before they died. And so this, you know, in hindsight, was called non beneficial treatment, because it didn't benefit the patient. And so the, the hospital wants to know why these patients who were dying, and you don't only have a few weeks to live, we're receiving such aggressive therapy. And, you know, when this question was brought to us, we knew what we have to do, we want it to reduce the non beneficial treatment, or the unnecessary er admissions for these patients who would much rather prefer to, you know, spend their last few days at home with their family, rather than be receiving aggressive chemo or other treatment. So that was our goal was to also improve the quality of life of these patients and end of life. But the question was about how do we do this. And so you know, this took us almost a year of trying to understand the cascade of events that leads cancer patients to end up at that stage where they're receiving non beneficial treatment, or they're receiving aggressive treatment, or they're, you know, they're being admitted into the ER continuously in the days before they die. And after all of this work it you know, we realise that one of the best ways to do so would be to initiate early palliative care for these patients. Now, you know, most people have a negative connotation of what Palliative care is. And so this became a barrier. Because patients, if you tell them, Hey, we're thinking that you should see a palliative care specialist. For them, that immediately means we're stopping their treatment and then moving them to palliative care.
Sorry, can you just explain what Palliative care is?
So palliative care, that will actually that's the definition that's a moving target, really, but in general pattern cares for patients at the end of life, who can no longer benefit from curative treatments, so their treatments have now been moved to just making them comfortable. So there are the medications and treatment they're receiving is just to pay the symptoms, so to reduce pain to make them uncomfortable in their last few months or weeks before their presumed death. And so that is the connotation associated with palliative care that that means that their doctors have given up hope on them. And so usually most patients and so our initiative was for stage four lung cancer patients and up until recently, stage four is the worst, the most advanced stage of lung cancer. And these patients usually has six months to live. And so you would assume that such patients would naturally be referred to palliative care. So they would see a palliative care physician who would then need them through these, the process of coming to terms with their situation and this initiative of trying to refer patients to palliative care as the whole goal was to make sure that these patients have this conversation about their end of life goals. And you know, there's the literature was showing that if patients are prepared, then they don't end up in the ER at end of life that they you know, they have a very clear idea of where they want to spend their time be it at home or surrounded by family and they also have very clear idea of what they want in terms of treatment, identify, you know, they don't want anything aggressive, they don't want to be intubated. They just want, you know, maybe the bare minimum to be comfortable. So that's what led us to the idea that what we want to implement is make sure that these patients are having conversations with their doctors earlier on. So the initiative that we wanted to implement the change, let's say, for these patients to improve their outcomes, that end of life was to just ensure that they have these conversations already earlier in their trajectory. And what we were seeing was that these patients were not having these conversations with be at their, their treating physicians, so their oncologist or the perder, care physician, they weren't, they weren't even being referred to palliative care. So they weren't having these conversations. So this the initiative, it's quite complex, because we want to ensure that these patients are having these conversations. But at the same time, patients are now living longer. So they don't often consider themselves at end of life, and they don't want to be referred to palliative care, especially if the connotation is that it is end of life. And so, you know, a lot of our initiative is understanding the patient barriers, the clinician barriers, having these focus groups with the different stakeholders to see how we can overcome these barriers? And what is the best way to implement what we want to do? What is the best way to have these conversations earlier with the patients so that they are prepared for that eventuality? Should you know their end of life be far earlier than they had imagined it would be? So that's one of the initiatives we're looking at?
Yeah, it's a tricky one. And it involves kind of ethical questions as well, you know, like, do you want to do everything you can do to, you know, increase your length of life? Or do you want to focus on improving the quality of that last little bit? And yeah, I can see how that's a tough area to navigate.
Yes. And I mean, I think one of one of these issues is that we're working with different clinical teams to have different goals, right, your treating physician, their entire goal is to treat you so that you can get better. While the pilot of care physicians, that's not their goal, their goal is to make you comfortable. So their goal is to make sure you understand the nature of your disease, make you see, you know, what the eventuality may be. For them, they're like, Look, we hope that you will get better. But in the event that you don't, you need to have a plan. And that's what that's where they come in, you know, they come in with all of these other with the plan B at the Plan C, which is not offered to patients, because usually the treating physician doesn't want to start talking about death right away, right? It's uncomfortable from another as well. So usually, you know, if you go, if you have cancer, and you go see your treating physician, they want to give you hope, and they want to show you all of the treatment options available. But they don't really want to talk to you right away about, okay, your way you got to do it end of life of all of these treatments don't work. So that's why you have like these two different perspectives from the different clinicians, clinical teams. And, you know, getting those two to come on the same page is a challenge for our team. You know, since this is one of the challenges that we face is how do we bring these two teams together, so that we can work towards this common because of course, even the treating physicians understand that they need to improve end of life care for the patients. So it's, you know, it's very much how do we bring everybody together and work together? And this is a challenge for us.
Yeah, thank you for explaining that. So you gave us an example of the gel as a technology that you've assessed and you've decided not to implement. And then we kind of talked about the palliative care as an example of kind of like a policy you would implement to improve the quality of how the hospital functions. And I was also wondering if you have any examples of technology that you've looked into, and that you've actually ended up implementing in the hospital?
Yes. So our unit has three types of recommendations policy recommendations that we make, we can choose to approve it or not prove it. But we also have this middle ground where we can say approved for evaluation, which really means that there is a signal that something will work. But the evidence isn't quite strong enough yet. So we're saying that the hospital will fund doing a little evaluation project or a research project where we will, you know, allow them to look at it for a year or so and then collect data so that we can actually evaluate whether it's doing anything, whether it's effective and safe within a hospital setting. So that's often our middle ground where we think a device is promising, and we don't want to outright reject it, but we also can't, you know, in good faith, approve it given that the evidence is strong enough. So most recently, we have Two biomarkers. So they were they're really blood tests. And the most recent one was a blood test that could replace your cholesterol. I'm sure both of you are familiar with cholesterol testing. You've heard of the good and bad cholesterol. So usually your family doctor would run a lipid test. And you know, they may tell you, Hey, your cholesterol is high. And so this test, actually, this novel test has been shown to be actually better than the cholesterol testing that we have been doing for decades now, your usual high and low cholesterol tests. And the curious thing about this test was that, you know, when the doctor who's been who was promoting, or really advocating the use of this test came to us, they was decades of research on this. And so when I looked into it, it was quite surprising and how, how much research was available and how strong the evidence was. But one was curious about this particular example is that the reason the test wasn't adapted into current practice yet is, you know, there's there were all of these different factors. So a lot of it was inertia. You know, people saying, oh, but everybody, you know, the doctors and the nurses and the patients, they know what cholesterol tests is, we've been using them for so long, I want to be confusing to everyone if we just remove them and put in an entirely new test, and no one will know what that even means. No one wanted to shake the boat too much, I think you know, so they're saying, look, if this test is it's been working fine, then why do we need to fix it. And so this, our report actually had to show why this novel test was actually better than the current lipid tests, and why it would actually benefit doctors and patients to use it, because there were certain populations that who were being missed by the current cholesterol testing, and it was, you know, it would be really, really beneficial to them to have this new test. It was interesting, because in terms of the evidence, you know, when we brought our we wrote the report and brought the report to the policy committee, everyone was like, well, this is very straightforward. I mean, why are we even discussing this, of course, this shouldn't be approved. But the doctor who had advocated for this test was very nervous, because it had been dead decades and decades of him fighting to put this test into practice. But coming up against a wall, it was almost, you know, political. And, you know, I think this happens quite often, right? Because you have people who are just used to something for so very long, that they become very attached to that particular test. And it becomes very difficult to change people's mindsets about something. And I think this is what you know, he was coming up against is that we just don't understand why they should change your way of doing things. We've been doing this for decades. And it was almost, you know, it wasn't really based on on any scientific evidence. It was just, this is the way we do things. So why should we change? And I think this is another challenge that we face as a health technology assessment unit is effecting cultural change, you know, changing the way people think changing their mentality about things, because most people are just so happy with doing things the way they're doing it that they don't, you know, they don't want to change. And that's, that's our role is to write these reports and present the evidence, because you can't argue with the data, right? You can't argue with science. And so it's to promote the science and let that do the speaking. And that's what we saw with this. This report, it was really it was very fascinating is that when we let the science speak, everyone was, you know, convinced this, they said, Sure, we don't see why we shouldn't approve this. But now we are left with the second phase is hard to be now promote this to the general public, right to the doctors who order these tests to the patients. So we basically have to start an educational campaign to educate all the clinicians and the patients about this particular test and how it's more beneficial and better than the old one. So our work isn't done, we've approved the test, but now we actually need to make sure that people will use
it. That's really cool. It's also kind of cool how it's a combination of you know, like science and looking into the literature but also kind of more policy or like almost like social justice you type.
Yes. You know, my boss used to say it's like we are the United Nations and we have to do diplomacy on a daily basis. I mean, you're everyone's on the same page, but they also have their own agendas and their own priorities sometimes and so it's really just getting people to see what the their main objective is right. And being part of the hospital, our main objective is ensuring that the patients get the best quality care. And once we show them the evidence that one, you know, one intervention or device works far better than the alternative, then there's very little that they can do to argue against it. And that's what we do, you know, we don't really have an investment either way, right? Like, we usually when someone comes to us and says, Hey, evaluate this particular device or intervention, we are completely unprejudiced. And I think that's why it's so important for us to be involved, because we don't really have any ulterior motive, right, like, we're here just to make sure that the science is front and centre. And that's what we do
know. So you mentioned some broad criteria about what you would use to evaluate new technologies or procedures in the hospital. But can you tell us a little bit more about the nitty gritty in the average day of work for you?
Yes. So it depends, again, on which aspect I'm looking at. So if I'm working on a health technology assessment, as I mentioned, it's, it's more straight forward in a sense that, you know, we review the literature. And then it's a lot of all of the epidemiological tools that we have learned about assessing the quality of the evidence, looking at all of the biases, has the study been done properly, designed properly, a lot of bias statistical methodology as well. So you know, it takes quite a long time, not just to first identify the literature that's already there. But then to review it properly, and to then synthesise all of that evidence, you know, sometimes you may have when you one study, and that makes that very easy. But other times, you could have 50, or 100 studies being published. And all of that evidence needs to be read, reviewed, evaluated, and then synthesised into a report that can't be terribly long, because, you know, we, these are the conditions who are reading it, so we need to make sure that they keep their attention. And so the nitty gritty of the health technology assessment is, is that kind of work is that we evaluated and then we synthesise it writing the report is actually quite difficult, because we have to, you know, take all that information that we've read and seen, and then, you know, write maybe a 10 page report,
this might seem a little strange to you, but we want to go into even more detail, we want to know, we would wonder if you could tell us, like, what hour of the day, you would usually get to work, when you would take a lunch break, how many hours you usually work a day or a week, that kind of thing.
Okay, well, so the hospital, it's safe, 35 Hour Work Week. So I guess that's like seven hours a day of work. And so, you know, it could be a nine to five day, and then you have an hour for lunch. And so bad pre pandemic times, I guess I would go into work, you know, I say I'd get there at 830 or nine, you know, start on whatever project I'm working on. So if this was the HUD technology assessment, I'd be basically doing my literature review or writing my report, or often part of this is also meeting with the clinical team that requested the report to understand their needs. So that would be part of my day, if I'm doing a hub, a hospital quality improvement initiative, there's a lot more involved. So I could be doing focus groups, which means that I have to first recruit the people to our fourth group. So we've done a couple of focus groups with the clinical teams. And that would mean, we have to reach out to clinicians to participate. And that is not easy to do it to get, you know, very busy doctors to participate in an hour to two hours after compensation. So just recruiting the doctors into these focus groups is quite the challenge. And so part of my day would be coordinating all of these different activities. It's interesting, because actually, the focus groups that we have done have all been during the pandemic. So they've all been virtual, on zoom. And, you know, in a way, you know, there's pros and cons to that the pros have been that people have been able to call in from no matter where so you know, if they were at their chalet in the middle of Quebec, they were still able to call in, I think that the cons were that I wasn't, oftentimes they don't turn their cameras on. So you can't really see people's expressions. You can't see people nodding, you don't really know what they're thinking, you know, you hear a lot of radio silence and you don't know what's happening. And I think you know, that's an essential part of a focus group is that is to see the interpersonal reactions and the expressions that people have and That that was definitely a challenge. But so you know, those have been the the daily aspects of, of doing quality improvement initiatives, you know, quality improvement initiative is, it's still a lot of background research as well, right? For example, we're looking at patient education. In fact, we want to do a patient focus group, and I used to do that we have to decide what we're going to ask them to do that we need to look at the literature to see, you know, has this already been done before? What are patients perspectives on palliative care? How do they react, what would be their potential barriers, you know, so there's also still a bunch of reading to do a lot of background research to be done, that would then inform our questions, and then you know, they'd be have to coordinate the actual focus groups. So in terms of the quality improvement initiatives, there's quite a bit of coordination at sea, you know, still a lot of research, but just to start to get that project off the ground, there's a lot of coordinating the different pieces involved. So the different teams, our own team members, and then once that project is off the ground, you know, like for this lung cancer palliative care project, we haven't yet entered the implementation phase, we're still doing focus groups to understand what the situation in the ground is. And then once we implemented, we're going to have to have a long process where we're actually collecting data, you know, saying, hey, are these doctors having conversations with patients, if they're having conversations with patients, what are the downstream effects, have er admissions been reduced, has non beneficial treatment at end of life and reduced, so this is basically an auditing process. So we then look to measure these outcomes. So another important aspect that I failed to mention earlier, to us, it's extremely important to us is access to data. Now, our hospitals are still, you know, not up to date with properly collecting data. So you know, you may have heard about electronic health records and everybody trying to get on that ship. But the electronic health records have been framed, you know, with clinicians in mind, in the sense that it's like, okay, let's just make sure that all of this is available in electronic format. So what that means is say you go to a doctor, and then the doctor takes all of these progress notes, then what they do is they just scan it into their software, that doesn't help researchers, because when we want data, we want it to be accessible to us in a research format. That means if we say, Hey, can you please pull up all the data for the last year for patients who were, you know, had stage four lung cancer, and who were referred to palliative care that cannot be done, because it's in a form, you know, you cannot access scan data, right, it's just not usable. And so while it's an electronic format, it's not in a format that's available for us to use as researchers. And this is just coming on board where they have now realised that, you know, hospitals sit, they sit on troves of incredible data, that if we could just access it, we could answer so many questions, and do so many quality improvement studies, the only thing is we cannot access this data. And it's not just getting data, right, you have the data has to be complete, it has to be accurate. So that you are, you know, whatever your interpretations are, are accurate as well, you don't want to be working with incomplete data, and then coming to false conclusions. So you know, this is a huge process where the hospital has to ensure that they're collecting all the data, and they're collecting it properly. And that it's accessible to the researchers who want to look at, and this is just the brand new initiative that the hospital is, is developing, which would make our lives so much better, because you will be able to run these quality improvement initiatives, do the audit team, look at all of this data, and come up with better solutions. So I'm hoping that this, this falls into place soon. But again, it's a work in progress and what people have been doing before this is actually just going to patient charts. So you know, the column chart reviews, but you actually have to hand review charts. And you can Yeah, you can't you can can you imagine that? That is simply impossible, not just in terms of volume that also trying to decipher 100 notes. I mean, that's just you know, not feasible.
There's always the joke that like doctors have like the worst handwriting. Yes,
exactly. And even today, I mean, you know, these are these are barriers, but even today, doctors handwrite their notes and this is an important problem because if their notes Sort of illegible, then what kind of communication is there, right? Because if one team is relying on just reading the progress notes from another doctor, and they can't even read them, then there is effectively no communication between the teams, right. And this is why electronic health record records are so important, because if everything was available in a logical format, on, you know, online somewhere, and it will be accessible to all of the, the whole team that stream that patient, you know, there would be so many issues solved one doctors would know what has already been, you know, one team would know what the other team has done, which is not always the case. No, you wouldn't have you know, missing data, because you don't really know what's happening. A lot of the doctors don't understand what has already been done. So in our case, with the end of life, palliative care, the palliative care physicians often see, they don't know, what has been told to the patient, in the senses have, they already had this conversation about end of life about advanced care planning, they don't know. Because when that patient comes to them, they have no information. All they have is a referral form where the patient has not been referred to them. But they have no other information on the history of that patient, or what conversations they've had, then, so you can imagine if you had the central repository of that patient's file and data in an electronic format, it would make the doctor's life so much easier. And it would improve patient care. So this is, you know, I mean, it's it's a no brainer, but it's a difficult task to accomplish. So these are works in progress.
Yeah, that makes a lot of sense. It's interesting that like a lot of, you know, improving the hospital and things like that. It's not even really about the science, but it can also be just like communication happening better and having.
In fact, I mean, this whole this lung cancer palliative care project, you know, the more we did the focus groups, and the more we talked to the different stakeholders, we realised that it's, it's actually an issue of communication at every level communication between the patient and the doctor, which doesn't happen, right? having that conversation, it doesn't happen between the patient and the doctor. And then communication within the team of doctors. So within their own teams, sometimes the doctors and nurses are not on the same page, because important information hasn't been communicated to the nurses who are involved in the care of that patient. And then communication between the teams, that's there's a huge communication gap, what between, you know, the treating physicians and the powder care physicians, and this is again, huge, right? So at every step, there is a ball being dropped. So at the very end, it's almost like there is no communication at all, there is no information. And this is why a patient may end up in the ER or end up receiving all sorts of unnecessary treatment, because at no point was the patient's wishes ever communicated, or written down. And so as you said, communication is one of the most important factors. And if we can just facilitate that through some format, but it would be easily accessible electronically, I think this would really facilitate matters.
Yeah, that makes a lot of sense. For the people who are working in the health technology assessment unit right now. Can you speak a little bit to their qualifications and experience? Sure. So
we usually our team members have a background in epidemiology or public health. So if we have a higher research assistance, they need to have at least a master's level degree in epidemiology or public health because a lot of thorough literature review, you need to have very specific skills to understand, you know, the bias use and the quality issues with the studies, we also require analysts, so usually biostatisticians. And again, you know, having a Master's is very, very helpful, because you just learn all of these advanced techniques that you may not necessarily learn, but an undergrad degree. And then we also need health economist because I mentioned many times that we look at budget impact and a cost effective analysis, and how the economist study these issues. And they know and, you know, again, there's very specific methodology involved. So, you know, those are the skills that we usually look for when we hire people in our team. All right, well,
thank you for that. Is there anything else you would like to add before we wrap up?
Um, yeah, I just I guess I just wanted to answer one of your last questions was how did you go from your undergraduate field to right now?
Yeah, sure. Yeah. Do you have time to talk about that? We'd love to know.
Yeah, I mean, I guess just because it's it's an it's an unorthodox pathway. Because I mean, I started in biology, and I assumed I would be doing, you know, like, basic science research in a Web Lab. And that's what I started doing. But while I was doing basic research, it's kind of felt that what I was doing was very specific and a bit disconnected from, I think the end result after the policy impact I wanted to see, you know, I felt like I was missing the forest for the trees that I was doing was very, very specific.
Yeah, looking at like one tree.
Yes. I mean, you're, you're looking at cells. And under a microscope, you're like, yes, what I'm doing is very worthwhile. But I would really like, you know, there, there would there's a long pathway from that to the final impact. So I, when I was, you know, an undergrad, I had never heard of the field of epidemiology, though, everyone knows what that is, and how what the current pandemic, but back then, you know, I had to research kind of from coming at command from a different angle, because it's like, this is what I want to do, I want to actually be able to see a more direct impact of my research on health policy, during my research that what came up was epidemiology and public health. And so that's when I looked into that a little more, and ended up in that field and chose to do, you know, Masters and PhD, but when I finished my PhD with a degree in epidemiology, so if you don't want to go into academia, you know, there's other non academic jobs where they're hire epidemiologists or health analyst, but again, when I finished my PhD, I've never really heard about health technology assessment in very specific terms. And it was just that I came across this job posting, where they were looking for epidemiologist, and it was fascinating to me that he this was an avenue for epidemiologists to work in, because most people, you know, they think that they need to work in see public health setting like Health Canada, or the Public Health Agency of Canada, where they actually, you know, where they hire epidemiologist, mostly to work on infectious diseases. But there are other avenues as well, for repeating geologists, so it doesn't necessarily have to be quite contained.
Yeah, super cool. You'd be surprised, like a lot of people have kind of a windy path. It's actually I think it's more common than not, if, if that's interesting to you at all,
no, it's nice, I guess, you know, when people choose to do PhDs, you know, you're feeling like your options are very narrow, and that you've, you know, now you've taken on the academic path, and that's the only way to go, and you need to get a job and a university. Absolutely. But even you know, when I was looking, when I, when I finally decided I didn't want to go into academia, you know, all the jobs that were non academic, were often in these public health agencies, and where they often tend to do you know, surveillance or infectious diseases, components. And so having not, you know, my when I did my PhD, was an in infectious diseases, epidemiology, you know, you can do a PDR at various different fields. And so, again, I felt it was a little bit constrained because there weren't jobs exactly, in what I was looking at. And so, you know, it was nice to see that epidemiologist can still be quite versatile and that you don't have to go into a particular area, and that the different options out there.
Yeah, that's pretty cool. I'm not sure if I missed it. But did you go straight from your undergrad into grad school?
No, I worked in a lab for a bit. And then I opted my undergrad, I did some wet lab research. But then after a while I was this is when I was kind of trying to figure out my path in life. And, you know, I had decided to, I did think lab work was what I wanted to do. So before I went into my master's, I worked with an A perinatal epidemiologist. So he was someone who looked at the determinants of disease or conditions in pregnant women. And so I worked with him as a research assistant, just to see whether I liked it, and then decided that Yep, that was something I wanted to do. And so I applied for a Master's. Sounds good.
Yeah. Thank you for sharing that story with us. And thank you so much for just coming in and chatting with us today. It was great to hear about your work. Thank you. Yeah, I'm happy to share it with you. If you would like to learn more about the McGill health technology assessment unit, you can visit their website at the link in the show notes. So we wanted to take this moment to tell you about our Patreon. We're raising funds in order to help pay for a podcast hosting service equipment upgrades and our own website. If you head over to patreon.com slash so you got a life side degree you can view our three membership levels And the cool perks that come with them. For $1 a month, you can access bonus mini casts, which are five to 10 minute episodes where we talk about the interesting shenanigans in our lives, including weird animal discoveries, like the truth behind blobfish. To check out this and our other perks, click on over to patreon.com slash so you got to live side agree. So, Lisa, what are your thoughts? I thought it was funny how she was like, Yeah, I was working in research, and I just really didn't like how I felt like I couldn't see the forest for the trees, because I'm just like, I love the trees. I
love individual trees,
individual views on individual trees. I don't care about the forest. Yeah, actually, I was thinking about that earlier in the interview where I was like, that's the exact reason I also didn't like research is that our entire lab was like, okay, we're gonna spend two months figuring out how a Drosophila rolls and angle that a roll. How many times does it roll before it's stopping? Yeah, exactly.
Yeah,
people are so into just awful. And I just don't get a live at McMaster that they exclusively study just awful. And I went to this one seminar, where they were just talking about the Drosophila wings, and like the patterns in the wings, and then she put up like the person who's presenting, she put up two wings on the flight. And I was like, okay, she's talking about two identical beings. And that's what this slide is meant to illustrate. No, the slide was to illustrate differences in the way. Oh, and by the end of the seminar, like I was able to see it. So imagine two years of that. Yeah, the other thing is like the contrast from my reaction to my profs reaction where she's like, sitting at the edge of receipt, like so excited about yourself, or rolling and I'm okay, I clearly there's something here. Yeah, I like translational research. But I also don't mind working on a very, like, specific aspect. I'm like, I don't know, I don't I don't like humans. I like I like human cells, but I don't like I don't like too many cells, like as soon as they start to form an actual human that's
thinking earlier in the interview, but she also mentioned that her work is very much a combination of all the things that I like, where it's bio and econ and data analysis. Oh, yeah, I was gonna tease you about that. Because at one point, she was like, oh, my goodness, hospitals have so much data. And I was like, Oh, yeah, free is gonna be made up. Yeah. I mean, you'll definitely have a job. You could go into data science, so good for you. claps Yeah. But it's kind of cool in this unit that we talked about. Because I think in my personal life, and you do this to where like, you just try to optimise like every aspect of your life to some degree or like, what is the optimal way to budget or like have your sleep schedule? Yeah, let's see often way to stir my coffee counter clockwise. How we're talking here. Yeah. And this is actually a lot of what I like about Econ, where one definition of economics is just the study of decision making. And so this is like optimization on a larger scale, which I love.
Yeah, yeah, I
can see you do it's definitely like science involved as well. Yeah. Yeah. Yeah, pretty research based. It was pretty, it would be terrified to actually have her job. Like, that's the thing is, that's what I like, at least, as someone who has never done a research project yet. But like, I'm just terrified by the idea of I can make this one decision and that could literally impact who doesn't does not die. Like I know the same can be said for if you're working in like a lab that does cancer treatments, but it's it's so indirect. Yeah, for sure. Yeah. Yeah. This is a much more direct. Yeah, you're basically like the last while you're not like the doctor, but you're like the line before the doctor, you know, like, what can the doctors use? What what is out there? availability? Yeah. But it's also similar to I always forget the name of this, like the train problem or whatever. Where with the problem rolling problem? Yeah. where it's like, if you didn't do those research, like could there potentially be more harm than if you did it? I don't know. Right? Yeah. So that's my reconciliation for you. It's okay. I understand how it fits into the trolley problem. like would you push this researcher for the trolley to stop? What is the research in the trolley problem? Yeah, the research is like the switch. Like if you don't, yeah, okay. And that people are just people. Okay, that makes sense. Yeah.
What do you think about all her talk about inertia and like, you know, how it's hard to get people to change to new things because they want to stick with old stuff. Yeah, I think that's like a very serious issue. And a lot of these types of things, especially if it's like unintuitive like the change on the surface doesn't seem like the intuitive move, Mike. I have more of an economics example. But it's very broad. Yeah. I mean, I don't think it applies to just healthcare, I think, like applies to everything in the world. Yeah, I think last semester, we were learning about how I think this was after like World War Two or something, where actually, I don't know, what are the world wars where there was like a recession, and people were encouraged to like, save all their money and like, not spend anything, and just like really buckled down on their savings and stuff like that. But like after that period, it was kind of found out that like, the opposite is what you should be doing during right. Yeah, like when the economy is bad. You want to be like stimulating it. Yeah, exactly. Yeah. Now government give you like stimuluses to spend on right. Yeah. Yeah. So that's like, it's unintuitive. Oh, I see what you mean. Yeah. Yeah. Yeah. It's like, it's both like ingrained. The idea from before is like, Oh, you should like save money. Yeah. Which which might be true on an individual level. Yeah, exactly. Yeah. But the aggregate the opposite? Yeah, that's quite interesting. Mm hmm. But I guess kind of related is, like, we talked about how a lot of improving hospitals and patient care is not actually about the science or the technology that's coming out. It's really just like, human communication and like cooperation between, you know, nurses and doctors or, you know, understanding of what patients need. Yeah. And you she was saying, she was like, Oh, it's nice how you just use the science. You just put the science out there. And then it speaks for itself. And I was thinking, yeah, but that's because you work in a hospital. I can tell you most the time science doesn't speak for itself. Yeah, there's this guy who wrote a book about like checklists. And for solar. This was like, selling like snake oil. But his whole thing was like, original research was based off of hospitals where doctors would just be like, Oh, yeah, I know how to do this procedure. Like, you know, don't be little me like this. I don't need a checklist. But then once they start implementing checklists, like the patient care, and like, amount of incidents dropped dramatically, because it was just like, full would overestimate their ability to remember everything and like, you know, do things in a procedural manner. Yeah. So it's just like, yeah, little tweaks like that actually have huge consequences in a place like the like, Yeah, that's true. I also like how she pointed out that when you're introducing a new technology, it can't be as good as existing technology. It has to be better or at least, as good, but wait cheaper?
Okay. Yeah.
Yeah. Because you have to overcome that barrier of like, oh, everyone's super used to this thing. And it's working well, and we know its efficacy, and it's been well studied. So why would you introduce like this new thing that you hasn't been like, as thoroughly research? You know? Yeah, for sure. That makes sense. I mean, you can almost think of that as a cost of switching right and integrating that into the overall economist. I feel like you're like, what's that like that Schrodinger thing? where like, you are both an economist and a data scientist. That was I think you're insulting charging this guy. But he was insulting the cat. You know what, the cat's not real, right? No, I
know. I know. It's
like, haha, but like, it'd be actually a while ago.
What was the point you're making finished? It's all like, these fields are opposites, right? Like the line between Oh, yeah. Yeah, I don't really have a point to make with this. But she did mention like the electronic health records stuff. Oh, yeah. Yeah. Yeah. Why do doctors still handwrite? Oh, my goodness. I don't understand. Yeah, I mean, either. I think it is changing gradually. Yeah. Yeah. He would think that medicine is a field that needs to change like crazy. Yeah. Like, it needs to change fast. 50 years ago, like what we didn't even know how to sequence genes. Like, yeah, like kind of tangentially related whenever I have a friend who's like, Oh, I want to go into medicine or I want to become a dentist, or but especially the family doctor, one. I always want to ask them like, why but I don't want to be rude. Yeah, but then the other day, I was studying with this guy, who's like, in like, my biology class, we were doing like a group study session together. And then we were talking to him. And then I think, like, my friend asked him, like, what he like was going to go do and he was like, Oh, yeah, I'm going to go apply for med school. And I was like, but why? One thing that made me question the whole, I want to be a doctor thing even more when people like, tell me that they want to go into medicine is learning more about like, the whole effective altruism, community, stuff like that. And I've kind of given you this whole, I guess, speech before the meal. But basically, there's some research that shows that like, over the course of a doctor's career, they'll save approximately six people's lives. And that's like, a huge approximation because I'm trying to accumulate all the little actions that they do on a day to day basis type of thing. But if they had As donated I like some proportion of their salary for a number, like a fraction of the years of their entire career is way, way way wave realise. Yeah. So it's just like the whole thing of like, the usual response people give for going into medicine is like, I want to help people and like, save lives. And it's like, okay, but you could just go to a high paying job and donate your money, and you would do that. But that's also that's, it's less intuitive, right? Yeah. It doesn't give you the same feeling like it's both like people want to do actual good in the world. But people also want to feel like they're doing actual work and in the world. Yeah. But I just think people should like think a little bit more critically about their intentions for wanting to do this. Yeah. Yeah. That's interesting. Honestly, when I started going to science at Mac, I was I didn't care about like, I honestly didn't, it wasn't my intention. I was like, Oh, I want to like save, you know, like people and help get cured cancer that that wasn't really my I was just kind of like, Oh, my God, like cells are so cool. I was like, Oh, my God, what's that? It's worse. It's Oh, yeah. And yeah, I don't know. I guess over time, I'm like, Oh, yeah, cancer is pretty bad. Or, yeah, it gets just like the idea. It just sucks being in like, oh, you're sick, and there's nothing we can do to help you and die. And that's just like, that sucks. Yeah, that's totally true. Yeah. I also will say, though, that you do need to stop Pooh poohing on doctors.
PhDs? Yeah.
Like, it's still very viable career for life. And like, if you want to be a doctor, we need good talk to y'all. Sorry, I didn't. Okay. First of all, let me just point out that you were the one that brought this up. But also, that's true. No, the other thing is that I'm not saying doctors and people with PhDs are terrible, like Far from it. But it's more like you usually don't hear the opposite perspective. So I try to be relatively vocal to, you know, be even close to the opposite. Okay. This has been another episode of so you got a lifestyle degree with Nisha almeyda. about being a research scientist at McGill University's health technology assessment. You want to give special thanks to our crew of lovely patrons, including our little leaf pigeons named Daniel Shafiq and shamima. If you would like to become a supporter of this podcast, you can visit our patreon@patreon.com slash so you got Alexa degree. You can also rate us on Apple podcasts using the link in the show notes. The music you're hearing is no regrets from audio hub.com Thanks for listening and see you next time.