Elizabeth Pisani: The accidental epidemiologist

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Never happier than when I’m running Stata. Credit: Paul Lakatos

Public Health Consultant and Author, Elizabeth Pisani told us about how she stumbled upon a career in epidemiology.

“I never actually intended to come to the School. I had been working as a journalist in India, Indonesia and China, and I got very interested in the interaction between politics and population policy. I wanted to learn more about it, and signed up to do a masters in development studies at SOAS. But when I walked around campus on the first day looking for a lecturer who shared my interests, they all looked completely blank. Finally, a professor in the geography department said: “You need to be across the street, studying demography at the School of Hygiene.” So I walked across to the Centre for Population Studies, and knocked on the door.

Miraculously, I was allowed to join a Masters course in Medical Demography. It was pretty scary; my first degree was in Classical Chinese at Oxford and there were only six of us in the whole university studying it. At LSHTM, I suddenly found myself in a big lecture theatre full of incredibly smart people from all over the world, and they were all speaking a language I didn’t understand. Though I’d been writing about cholera epidemics and emergency medicine for the world’s leading news agency, I didn’t even know the difference between prevalence and incidence. The School opened the door to a whole new world for me, and though I had to work triple-time to get up to speed, I enjoyed the constant discoveries of that year more than any of my studies before or since.

There were downsides to coming from such a different background. I struggled at first with the formulaic way in which science papers are written, and was surprised that so little attention was paid to the political and cultural contexts which shape the use of scientific evidence.  Many of my colleagues in the student body came from government departments in low-income countries, and they were all too familiar with the constraints on the use of evidence. Yet back then, some of the lecturers seemed to think that a good p value published in the New England Journal was enough to change policy.

In retrospect, I am very grateful for the focus on strong analytic and technical skills because it forced me to learn things I’d have been scared to even try to grasp. It also enabled me to morph into a technical role working with UNAIDS, WHO and others to try to improve the surveillance methods and systems that help us understand (and ultimately prevent) the spread of HIV. Now, when students ask for my advice about which courses to take, I tend to stress the nerdier modules, on the basis that it’s hard to learn about a Poisson regression by reading the newspapers, talking to people and observing what’s going on around you. Politics and culture you can absorb more easily that way.

I came back to LSHTM to do my PhD in Infectious Disease Epidemiology from 2003-2006. Since then I’ve been self-employed. I run a tiny public health consultancy called Ternyata (the name comes from an Indonesian word that implies that things don’t always turn out the way you expect).  But I’ve continued to work closely with many LSHTM researchers, and also sometimes lecture at the school. I never fail to be impressed by the breadth of experience and interests among the students.

Though I teach a course in scientific publication for mid-career researchers in middle income countries, I spend a lot of my own time exploring ways of communicating data that go beyond journal papers and policy briefs. I’ve written a mass-market book about epidemiology with the unlikely title The Wisdom of Whores, and am currently working on Song of Contagion, a crazy collaboration with a multi-ethnic orchestra in which we’re trying to turn inequity in global health into music. If you’re in London in June and curious about how that might happen, come and see the show http://songofcontagion.com.

I think the moment that underlined for me how useful it can be to talk to different audiences was when I got an e-mail from a Swedish MP. He said he had seen a TED talk I had given about why people take risks with their health, and noticed how strongly the data supported providing clean injecting equipment to drug users. After asking his aides to verify the data, he persuaded his party to support harm reduction programmes. “Next week, we open the first needle exchange in Stockholm”, he wrote. To me, that was better than a first-author paper in The Lancet and a whole handful of citations.

Lately I’ve shifted away from field studies into more policy-related work, especially looking at how the research process itself can be strengthened, so that findings are more likely to be translated into healthier and happier lives. However, I have a secret yearning to get back to number-crunching. Though my skills have atrophied horribly, I’m never happier than when I’m running Stata. That’s something I’d never have guessed during my first, terrifying medical statistics lecture nearly 25 years ago”.

Feature image – Mapping gay brothels in Jakarta. Credit: Philippe Girault

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