Interview with Alvin I. Mushlin, MD, ScM
Recently, Dr. Mushlin was asked several interview questions about his work. Below are the questions and his answers:
- Why did you go into research?
Early in my clinical training, I became very convinced that there was a tremendous amount of uncertainty with regard to how doctors should treat specific patients for certain conditions. I felt that determining best practices, while assisted by basic science research, could and ought to be aided by public health research and methods developed in the social sciences. I recognized that I personally had more interests and abilities in these disciplines than I did in biomedical research, and that there might be a real opportunity to make an impact on healthcare through my efforts. For me, I saw this as an opportunity not only to be personally involved in public health research but also working, more generally, to build the academic infrastructure for this kind of research on the institutional level. My work in developing the Department of Public Health at Weill Cornell Medical College, including its numerous and fruitful collaborative projects and relationships, is a prime example of infrastructure development.
- What work are you most proud of?
There are three areas of my work of which I am especially proud. First, I had an opportunity to develop a comprehensive approach to technology assessment, particularly diagnostic technology assessment. We did this work through assessments of the accuracy and utility of magnetic resonance imaging in diagnosing patients with neurologic symptoms suspected of having multiple sclerosis. This work led to three papers, the primary one of which was published in the Journal of the American Medical Association.
Second, I recognized early on that the missing part of the equation in developing clinical health policy was the lack of consideration of economics, specifically, the cost-effectiveness of medical diagnostic, treatment and prevention modalities. I had the opportunity to be involved in a series of randomized controlled trials evaluating automatic implantable cardioverter-defibrillators (the MADIT trials); I was responsible for the economic component. The resulting publications reflected one of the largest and most comprehensive economic evaluations of a new technology ever performed in conjunction with a randomized controlled trial.
I am also proud of my work in building the Department of Public Health at Weill Cornell Medical Center. I had the opportunity here to think about what a medical school needed to bring the public health and social science perspective to the forefront in teaching and research. I am proud of the growth and profile we’ve developed—I hope that we have become a model for other medical schools and that we have helped to pave the way for academic medicine to realize the value that our disciplines bring to the table.
- What’s a puzzle you would like to solve?
I want to figure out how we can finally get around needing to do randomized controlled trials (RCTs) for the evaluation of every new drug, device, or approach in medicine. That is, how can researchers use observational data sets (i.e., electronic health records, registries, hospital data, administrative data) to clearly indicate whether one treatment, diagnostic test, or prevention approach is better than another? While RCTs are recognized as producing the most reliable data, they can be very expensive to conduct and can take a long time to produce results. Innovations in study design and statistics, as well as better methods of record-keeping, could make these existing data the keys to important medical research in the future.
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