Building a research career on ancillary studies

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Building a research career on ancillary studies

• Kirsten Bibbins-Domingo, PhD, MD
• Associate Professor of Medicine and of
  Epidemiology and Biostatistics

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Outline

• Intro - goals of junior faculty researchers
• My experience and lessons learned
• Pros and cons of ancillary studies and additional
  thoughts on building your career

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Goals of junior faculty researchers

• Acquire skills in clinical research
• Publish papers (lots of them!)
• Gain recognition as an expert in a content area
• Get grants funded (hopefully big ones!)
• Accomplish all of this in a defined period of
  time
• Ancillary studies can be an efficient way to
  accomplish these goals

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My experience

• Goal
• to identify individuals at risk for heart failure
  in order to modify this risk
• to improve heart failure care in the outpatient
  general medicine practice
• Heart failure in HERS
• BNP in Heart and Soul
• Heart failure, cystatin C, BNP and more in CARDIA

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Heart failure in HERS

• My question as a resident which women are at
  risk for heart failure?
• In HERS
• What clinical factors are associated with
  incident heart failure in women with coronary
  disease and no heart failure?
• What other clinical factors increase the risk of
  death among women with heart failure and coronary
  disease?
• Does estrogen increase the risk of death among
  women with heart failure and coronary disease?
• Learned analyses through biostats courses
• 3 publications - Circulation, others

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Heart failure in HERS

• What worked?
• Studying an outcome that others are not studying
• What was gained?
• Achieved some goals (skills, papers, reputation?)
• Collaborate with senior clinical researchers at
  UCSF
• Pitfalls?

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Potential pitfalls

• Data not collected for this research question
• Some secondary questions work, some dont
• Self-report of heart failure
• Dont force it just because data available to
  you.

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BNP in Heart and Soul

• My question as a fellow can BNP be used in the
  outpatient setting to manage heart failure more
  effectively? An RCT
• In Heart and Soul
• Is BNP as a useful screening test to detect LV
  dysfunction? X-sectional study
• Analyses in biostatistics course
• 2 papers (Circulation, Am J Med)
• Received intramural grant for more assays (REAC)
• 5 papers (JAMA, others)

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BNP in Heart and Soul

• What worked?
• Switch from a project not feasible to a related
  project that was feasible

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BNP in Heart and Soul

• What was gained?
• More goals accomplished
• Continue to expand collaborators at UCSF
• Adding new measures a gift that keeps on giving!

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Potential pitfalls?

• Whos the boss?
• Service to the parent study
• Gaining independence

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Heart failure in CARDIA

• My question as a junior faculty Why are my
  heart failure patients so young?

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CARDIA

• NHLBI-funded cohort study designed to examine how
  heart disease develops in young adults
• 5115 young adults age 18-30 yrs in 1985
• Men and women
• Black and white
• Low and high SES
• Followed nearly 25 years (exams at years 0, 2, 5,
  7, 10 15, 20, new 25)
• Medical history, psychosocial variables, blood
  tests, diet and exercise, subclinical CHD,
  clinical cardiovascular endpoints

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Heart failure in CARDIA

• My question as a junior faculty Why are my
  heart failure patients so young?
• In CARDIA
• Incidence of heart failure in young and middle
  aged black and white adults
• Clinical antecedents of premature heart failure
• Chronic kidney disease and cardiovascular risk
• Cumulative exposure to cardiovascular risk
  factors (blood pressure, lipids) and subclinical
  cardiovascular disease
• Biochemical (BNP) and genetic precursors
• Social factors and heart failure risk
• Several paper (NEJM, Annals, Archives, others in
  progress)
• R01 from NIDDK (other grants planned).

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Heart failure in CARDIA

• What worked?
• Exactly the right dataset to answer research
  question
• What has been gained?
• Continue to work on goals
• Local and national collaborators
• NIH interest
• Broad base from which to explore multiple
  questions

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Other examples of ancillary studies

• Using publicly available data
• NHANES/NHIS/NHDS/NAMCS/ Vital Statistics
• Adding a new measure
• Incarceration in CARDIA
• ABI in CARDIA
• Analyzing data in new ways
• Interactions in genetic studies
• Decision and cost-effectiveness analyses

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Potential pitfalls

• So many research questions, so little time.
• Big family
• Bureaucracy
• Service
• Independence

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But Im interested in collecting my own data

• Ancillary studies may
• Lay the foundation (papers, reputation) for more
  competitive grant application
• Submitted RO1 for RCT
• Keep publications, reputation going during
  start-up phase of primary data collection

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But are ancillary studies really fundable?
PA-08-167 NIAAA R01 Secondary Analysis of
Existing Alcohol Epidemiology Data (R01)
RFA-HL-09-001 NHLBI Ancillary Studies in Clinical
Trials (R01)
PAR-09-252 NEI Research Grant for Secondary Data
Analysis (R21)
PA-09-131 NIDDK Secondary Analyses in Obesity,
Diabetes and Digestive and Kidney Diseases (R21)
PAR-09-247 R01 Ancillary Studies to Major Ongoing
Clinical Research Studies to Advance Areas of
Scientific Interest within the Mission of the
NIDDK (R01)
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Thoughts on building your career

• Be true to your interests
• Be flexible and recognize opportunities
• Re-evaluate your career development plan
  frequently and seek out ways to enhance

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Thoughts on building your career

• Concentrate on a few big ideas and the other
  stuff will follow
• Develop, nurture, and expand your circle of
  collaborators

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Mission Statements
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Mission Statement templates

• "To ... what you want to achieve, do or become
  ... so that ... reasons why it is important. I
  will do this by ... specific behaviors or
  actions you can use to get there.
• "To be known by ...an important person/group...
  as someone who is ...qualities you want to
  have... by ...some other person/group... as
  someone who is ...other qualities... ...
• "I value ...choose a value... because
  ...reasons why these values are important to
  you. Accordingly, I will ...what you can do to
  live by these values."