Our “Five Minutes With” series seeks to discover what are the habits, inspirations and obstacles that have shaped the careers of leading cancer researchers and influencers.
Professor Patti E. Gravitt, PhD, MS is a molecular epidemiologist whose research in human papillomavirus and cervical cancer spans the translational spectrum from the natural history of genital infection across the lifespan to the translation of evidence-based prevention tools to low and middle income countries. She is among the first to show an increase in screening coverage afforded by self-collected sampling and HPV testing and the relatively poor performance of visual inspection methods where intensive international technical assistance and training are not available (i.e., the majority of LMIC settings). She earned her PhD in Epidemiology from Johns Hopkins University Bloomberg School of Public Health and her MS in Biology from University of North Carolina, Charlotte.
When or where do you get your best research ideas?
This one is a hard one, not to be tripe but I often get them the same way other people do- when I’m driving, in the shower, usually when I’m doing something completely unrelated! I have to say, I’m someone who likes to connect dots and so I find a lot of times some of my best ideas come when I’m reading something tangential to my field, or going to a seminar or presentation and all of a sudden I start to see analogies or approaches that I was unaware of and begin to connect the dots, thinking “How can I use those in my work?”. It’s a little bit of the subconscious thinking and trying to go outside of your narrow focus.
What is the best piece of advice- work or life in general- that you’ve ever received?
I remember when my mentor, Dr. Keerti Shah, told me the following: “You talk too much and write too little.” I recall laughing with a bit of annoyance at the time, but I think what he was trying to say is that ideas aren’t really that helpful unless you act on them. Once you’ve said them out loud, they’re free domain. There’s a lot of competition in science, and I’m inherently a collaborative person and that’s what drew me into epidemiology to begin with. But it is competitive, and you’re taught by your mentors to keep things close and not give things away. This can be difficult, especially since I develop my ideas by talking them out with people. But he said, write things down, make sure you’ve made a stamp on things, but he also told me if you keep everything to yourself you won’t enjoy what you’re doing. So he helped me to find that balance.
What is your top life hack?
I’m a horrible procrastinator. I always say don’t ask me how to do things as I’m not the one to ask. I have found, particularly lately when I have a lot of writing to do, the one thing to get me into a more efficient mode is to get out a pen and paper and just start writing it long hand. I’ve found that if I can just do that until a lot of ideas are down on paper it stops you from begin so self-critical and just lets the ideas flow, and then I start typing them in and I can edit from there. I’ve found that can really get me started when I’m in that anxiety phase. There’s something about writing on paper, you really don’t have time to critique every word you’re writing.
What are you most passionate about or inspired by?
I’m on a kick lately. My work has been previously in molecular epidemiology where I was trying to understand the natural history of the biological mechanisms around HPV persistence, latency and reactivation, but I’ve really moved more recently into implementation research- we develop all of these novel interventions and screening strategies & tests, why people aren’t using them? In both areas, the thing that I have become really excited about is systems thinking, which is the idea that we’ve gone about as far as we can go with reductionist scientific approaches. A lot of things, including biological systems & healthcare delivery, are complex adaptive systems and they change in ways which are very unpredictable. There are ways we can embrace that unpredictability rather than try and control it and still learn things. I’m really excited about the value of simulation modelling, but for this to be maximally beneficial, we need to ‘re-embrace’ the value of descriptive data collection. There is merit in gaining a complete understanding of a system, describing the variability, see how it’s playing out over time, and then use technologies such as simulation help you see if there are particular patterns which tend to come up over and over again, and how contextual changes play out. I think those things are going to be a lot more affirmative over the long run compared to the strict hypothesis testing paradigms of controlled trials. I think the scientific community is still a bit uncertain about how to use these methods, but I’m excited about the potential.
What is the first thing you do after a grant rejection?
I definitely have a process. It usually starts with the immediate contempt…“How can they not understand how brilliant that is?!” then I move onto “The whole review process is broken! The scientific process is broken!” and then I usually go onto a complete self-doubt breakdown: “Oh my god, maybe I didn’t know at all what I was talking about?!” I go from that to “Okay, I can find constructive comments” and then I get back down to business and try again. I let myself be angry for a few days and then I try to see what I can do about it.
In your opinion, what’s the biggest advantage of HPV testing? Or what is the role of self-collected sampling in cervical cancer eradication?
I see the two as being very linked together. First of all, HPV testing is the only method that we have right now that would allow you to use a home sample, and I think that being allowed to have that self-collected sample has so many benefits from an implementation perspective; not only can it be less embarrassing to a woman and she feels she has more autonomy. But our experience on a study we’re doing In Peru shows that even if women are willing to be tested in the clinic, the need to find a bed for the women to lie down on, find a sterile speculum, everything you’d need for a Pap smear based program and visual inspection program can become serious barriers to screening at the volume needed. So even if the woman’s in the clinic, a midwife can just do a vaginal self-swab or hand it to the woman to do herself. It just frees up so much time and service delivery constraints that really do add up over time. We’ve found an incredibly strong, positive reaction from women and healthcare providers now they can screen many more women so much faster. That’s particularly true in rural areas, where they don’t have the staff so screening will be a lower priority. We can improve coverage substantially, and I think we should be looking at it in lower resource settings- there’s a huge advantage to it.
What’s the next big thing in cancer screening & prevention?
If we could acknowledge that the service delivery component, and understand how to deliver cancer screening and diagnosis, treatment, follow up from treatment and palliative care in a way that’s much more efficient… this could actually be as big of a game changer as the next big blockbuster drug. I think we don’t focus very much on the implementation parts. Going back to the idea of screening as a complex adaptive system; as screening and management algorithms become more complex, more people and health sectors become involved. We need to understand the behaviors and perspectives of all of these actors in order to design the delivery process in a way that minimizes certain bottlenecks. It’s really a matter of placing a higher value on understanding the worldviews and perspectives of the people who set policy, deliver services, and use services. Technologies are only successful if they are used appropriately, and that, I have learned, is quite a complex challenge. I think implementation research applied through a systems thinking lens will be a huge game changer.
Of the papers you have published over the last 5 years, which one is your favourite?
I’ve been very proud of my work in HPV latency & reactivation. One of the papers I’m most proud of is one where I connected the dots. I had a random idea after going to a talk which was focused on intestinal parasitic infection. I saw a global map of the endemicity of helminths and said “That looks exactly like the cervical cancer rates map” globally, the heat maps looked exactly the same. I actually went back to my office, pulled them both up, side by side and said, “That’s pretty remarkable”. The talk I was attending was really about the immunology of intestinal parasitic infection and the symbiotic infection with the host, but it was definitely skewing and polarising the immune system in a way I thought would not be conducive for strong antiviral responses. So I had an idea, “What if those helminth infections are causing a global immune dysregulation that is allowing HPV to persist a little better in a detectable state? Is that one of the reasons why we have this equatorial distribution of high rates of cervical cancer?” I then found Bob Gilman at John Hopkins who said “Let’s test it!” and lo and behold we found a 60% higher HPV prevalence in the 42% women infected with intestinal helminths in the Peruvian Amazon. We backed up this observation by looking at the cervical cytokine profiles which were skewed towards Th2-type immune response as expected. So we believe there is biological plausibility for this endemic infection to alter the natural history of HPV – and treating helminths is cheap and relatively simple. We’re still moving that forward to see if mass deworming of adult women might help us reduce HPV persistence in addition to screening and vaccination to reduce the burden of cervical cancer.
The views expressed are those of the author. Posting of the blog does not signify that the Cancer Prevention Group endorse those views or opinions.