This week, Eric talks with Brett Faine and Ken Saag, recipients of the UI College of Public Health’s 2022 Outstanding Alumni Awards. They cover a lot of ground, including their unique career paths, collaborative projects, and advice for current students.

Find our previous episodes on Spotify, Apple Podcasts, and SoundCloud.

Eric Ramos:

Hello everyone. Welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is Eric Ramos. And if this is your first time with us, welcome. We’re a student-run podcast that talks about major issues in public health and how they’re relevant to anyone, both in and outside the field of public health. Today we’re speaking with the 2022 Outstanding Alumni Award recipients, Dr. Brett Faine and Dr. Kenneth Saag. Dr. Brett Faine earned his doctor of pharmacy degree in 2007, and a master of science degree in epidemiology in 2016. He is now a clinical associate professor of pharmacy practice and emergency medicine here at the University of Iowa. Dr. Kenneth Saag earned his MD at Northwestern University in 1986, and his master of science degree in preventative medicine and environmental health epidemiology in 1993. He is now the Waters Endowed Chair in the Department of Medicine, and a professor and director of clinical immunology and rheumatology at the University of Alabama Birmingham. Both are here today to chat about their career paths and advice for current students.

Eric Ramos:

Welcome back to the University of Iowa. We’re happy to have you back with us today. To start, can you each talk a little bit about your career path and your current work?

Ken Saag:

Go ahead, Brett.

Brett Faine:

Yeah, so 15 years ago I started as the first emergency medicine clinical pharmacist here at the University of Iowa. Didn’t really have much intention of doing research or education, but then had a career trajectory change and went back and got my master’s in clinical investigation. And it’s changed my pathway, so now I have a joint appointment, like you mentioned, at the College of Pharmacy and Carver College of Medicine.

Ken Saag:

Yeah, so I was here starting in 1990. I came to the University of Iowa as a rheumatology fellow and recognized pretty quickly into my fellowship that I wanted to do research, but I didn’t see myself spending my career in the lab. And so I at that time partnered up with people in what was then called preventive medicine and also in general internal medicine. We didn’t have anyone in rheumatology who was doing clinical investigation, and they encouraged me to seek further training. So I had a chance to get an MSPH while I was here, or MSC, I guess. It’s an MSPH at my institution, so I forget the different designations. But, in any event, while here I had a chance to work with Bob Wallace and Betsy Chrischilles, and we’re talking with Brett, some of his colleagues over in the School of Pharmacy, and doing some pharmacoeconomic things. And things were going pretty well. We started a population based EPI program, established a cohort, got involved in some clinical trials thanks to Jim Torner’s encouragement to participate in osteoporosis work.

Ken Saag:

But I had a really nice opportunity both personally and professionally to move down to UAB, and since there have been involved still in population based EPI, but have shifted a little bit more towards implementation science and behavioral interventions. Have maintained an interest in clinical trials, particularly large phase three studies in gout and osteoporosis, and we’ve also had support from the Arthritis Institute to develop a gout center and arthritis centers, and have benefited from the infrastructure at UAB that’s allowed us to build these programs. But the thing that’s really keeps me going now is training the next generation. So I’ve started taking on leadership roles, and mentoring, and K grants, and T grants, and center directorships, and then recently as the division director.

Ken Saag:

The newest chapter has been doing national leadership with the American College of Rheumatology. I’m finishing up my year as president of that organization, and that allows you take you to an even bigger level to help inform policy and hopefully think about other ways that we can bring the next generation of investigators, and in this case clinicians and arthritis health professionals, along. So it’s been a little circuitous in some ways, but lots of fun and always interesting.

Eric Ramos:

Yeah, it sounds like you both have had some great careers. I know before this we were talking about passing the baton on, and you’re now talking about the next generation. What is some advice that you would give to current public health students either entering their field or starting out their career in public health or medicine?

Ken Saag:

Well, I think that the program here at Iowa is fantastic, and the thing that I encourage, particularly the physicians and people that don’t have a background in public health to do is to make it as quantitative as it can be. Getting good at working with data is such an important skill, and regardless of whether you’re the one actually eventually crunching the numbers, or if you’re talking to a biostatistician or a quantitative epidemiologist, you really have to understand what’s going on. So understanding study design and analysis, for me, is really the pivotal thing, and it’s a skill that you have to have if you’re going to be rigorous and you’re going to be competitive. Clearly getting the training, getting the imprimatur of being trained is important, but having those skills is the thing that we stress for everybody.

Brett Faine:

Yeah, I would agree with that sentiment. I think I’ll speak for the pharmacy side, we don’t spend a lot of time learning clinical research methodologies, statistics, things like that. They’re training us to be good pharmacists. And so really what I was lacking, and I think most curriculums are lacking, is that kind of background. And I would encourage anybody who really wants to take off in a research career to pursue some sort of masters in epidemiology, biostatistics, or clinical investigation, which blends the two of those together. So I think it just adds another layer, and really has opened up a lot of opportunities for me and it sounds like for Ken as well.

Eric Ramos:

Yeah. From your guys experience in medical education, pharmacy school, is population health something that you guys talk about in that education, or something you guys talked about, or is that later on in your career that you guys touched upon population health and those kind of topics?

Brett Faine:

Yeah, I mean that was something that really I didn’t even think about honestly. It was see a patient, help the patient. You learn how to read evidence and evaluate evidence, but it really wasn’t on a big level. So yeah, that was something that coming back to school that was brought to the forefront for me. So I think again, that’s just another aspect of things that just aren’t part of the curriculum currently that you can obtain by coming back to school.

Eric Ramos:

Yeah, definitely. So let’s go back to your time as a student. We’ve kind of already done that a little bit. Planned your unplanned, is there anything that you did as a student that you think was especially valuable? I know we kind of touched upon the importance of data collection and quantitative data, and it helped you get to where you are now.

Ken Saag:

One of the pieces of advice that I give our trainees is it’s about the mentor a lot, and getting the didactic training is key, but finding somebody who is invested in your career and will serve as your mentor. And really nowadays our thinking as a mentoring team. It’s a primary mentor and then other people that can bring other perspectives, big picture. Bob Wallace, for example, was a phenomenal big picture mentor. He has a perspective of what’s happening nationally that’s unparalleled. And then other people may be more technical and may help you with specific things. But finding the right person and being less… This is particularly true for clinicians. They want to work in a very specific subdiscipline. They want to focus on a disease or some sort of pathophysiologic process, say, in a more fundamental sense, but you want to get the training. It’s about the training, and it doesn’t really matter what the topic is. It’s about learning things that mentor can train you in.

Ken Saag:

And so I remember when I started, Bob put me on a biometry of aging grant. I wasn’t really interested in aging, but it was a chance to work with him, to be on that grant, and then ultimately got involved working with a project with Betsy Chrischilles and Linda Rubenstein, who was working with Betsy as a data manager analyst, really taught me a lot of things that were useful in propelling into directions that were more central to things that I ultimately wanted to do. But it was developing the skill set and the fundamentals.

Brett Faine:

Yeah, that’s absolutely 100% spot on. The didactics are great, but finding that mentor. The thing that was always told to me was that you should pursue a career development award. That was the big push. And luckily, Dr. Chrischilles served as my primary mentor and we had a great team. Unfortunately I wasn’t successful at obtaining that career development award, but it launched me into how do you obtain these things? How do you write grants? And there’s so many pieces that go into that, and she was such a great mentor along with the other team members. That really just opened my eyes to what will it take to achieve federal funding.

Eric Ramos:

Yeah, definitely. I really do value the importance of mentorship. I think that’s something I’ve heard a lot throughout my own career here at University of Iowa is get a mentor, get a mentor for all the things you guys said. They really provide you with that feedback, provide you with that insight. And feedback truly is a gift, so I think really having that mentor with you is especially valuable. Both of you have a clinical degree and a public health degree. How has your public health degree informed your clinical career? I know, Brett, you kind of talked about that a little bit with your pharmacy career. Is there anything else that you’d like to add about that?

Ken Saag:

Well, I would just say that regardless of whether even if you end up being an investigator or not, getting trained in epidemiology and quantitative methods in public health as a physician makes you a much, much better physician and a much better educated consumer of the information that you need to practice medicine. Being able to critically think about the literature. And it’s gotten much more complicated over the years in terms of study design and all sorts of things that you pick up in the general medical journals, just being able to read those papers. And understand the strengths and limitations of some of the things that are done. You ask, “How in the world did they ever get that published in New England Journal?” That’s not an uncommon reaction you have sometimes when you look at it critically. On the other hand, being able to look through all the literature and pick out the good, the bad, and the ugly that’s out there in the medical literature through a critical eye of what is evidence based medicine is partly what you gain from this sort of training.

Brett Faine:

Yeah, I think that’s a great point too. Even if you’re not going to be the investigator, it really helps you understand how to evaluate evidence, which I think is so important, especially with the sheer amount that comes out. It’s tough for anybody to stay on top of it, so if you can learn those methods and become more efficient at it, that’s also a helpful thing for all clinicians.

Eric Ramos:

Definitely. I think as we see kind of healthcare shift toward population health, value based health, and really evidence based practice, I think those methods that you guys are describing of really been able to hone in on articles, really being able to put evidence being practice at the forefront is going to be especially important. Looking back, what led you to focus on your current area of work? When you were a student at the College of Public Health, did you think you would end up or you are now?

Ken Saag:

Yeah, it’s interesting how careers take different directions and trajectory. I’m always a fan of serendipity. Being in the right place at the right time and having the right level of preparation can be very helpful. And it’s a mix, in my view, in being a successful investigator in both focus and opportunism. You need to be focused, you need to have the skills, you have to have particular things in mind that you do well and that people know you can do, but you also take advantage of what comes along, and things shift over time. There may be a new type of work or a new question. I mean, COVID being the perfect example of so many people just being ready with having the skill sets needed. And even in my area of rheumatology, there’s been just a plethora of questions around COVID and telehealth that we’ve been able to apply our interests and methodologies to. So I think that’s a big part of it.

Ken Saag:

And it’s nice if you have that clinical background because the questions come up naturally. You think about things where there’s gaps in evidence when you’re taking care of patients or, again, reading the literature that will motivate the next set of research questions that you might have.

Brett Faine:

Yeah, it’s having that adaptability, I think, is super important. You hit the nail on the head with COVID. I’m part of a research network that is a surveillance base the CDC funded. We weren’t doing COVID work, but when COVID came around, they said, “All right, you guys can do this.” And so being a part of that was super fantastic, and I’ve learned a lot from the senior investigators involved in that. But as far as my trajectory, I really enjoy, obviously, emergency medicine, but I also have a feel for infectious diseases. So been staying steady on that. But there’s always opportunities. I was able to do the NINDS StrokeNet fellowship, and it was one of those opportunities that just kind of fell into my lap.

Brett Faine:

I didn’t necessarily have a strong desire to do stroke research at that point in my career, but I looked at the team and I looked at the mentors and I said, “Well, I will learn a lot, even if this isn’t the kind of niche that I’m going to pursue afterward.” It allowed me to build those relationships and work with great mentors. So I think that’s also an important thing is sometimes you just have to be agile and say, “Is it necessarily exactly what I’m in? Maybe not, but am I going to gain some valuable experience? Yeah,” then you should take that opportunity.

Eric Ramos:

To date, what do you guys think has been the highlight of your career so far and why?

Ken Saag:

I’m really pleased this year that I am taking on this role with the ACR as president, and that was a long lead up to that working through committees and a leadership track. And it’s given me a chance to talk with people both within and outside of even the US around issues that are so central to our discipline at a time when there’s a lot of new challenges, so that has been my career highlight, is doing that. But at UAB and at Iowa, the thing that I’ve really started to enjoy is seeing the success of people that I’ve helped train. And I had been very lucky in a way to have some really fantastic trainees, some fellows and some postdocs who have come to me. And several of them would’ve done exceptionally well regardless of where they’d gone, because they’re so brilliant, but watching them succeed. And in some ways, it’s similar to being a parent. You want your kids and your trainees to exceed your abilities and your accomplishments, and seeing them excel and get recognized, you take a lot of satisfaction in that over time.

Brett Faine:

Yeah, I think watching your mentee succeed is great. I’m nowhere near as accomplished as Dr. Staag here, but for emergency medicine, clinical pharmacy, it’s a pretty infant job. Being 15 years on the job, I’m one of the older pharmacists that have been in emergency medicine. So one of the cool things that I’m really proud of is a friend of mine over at Loyola, we got together, it’s probably been about four years ago, and she had a interest in clinical research just same as I do. We were doing some good stuff at our own institutions, single center stuff, but that’s just less impactful. So we said, “Well, there’s a lot of eager pharmacists out there that are doing stuff at their own centers. Why don’t we create a network?” And so that’s what we did. It’s called EMPHARM-NET. So I’m one of the co-founders with Megan, and it’s pretty cool. We have 15 sites across the United States. We’ve received some small funding.

Brett Faine:

We just had our first project published, but that’s really cool because now we’re building this program involving more emergency medicine clinical pharmacists, and helping mentor them or bring them up. And we’re supportive of new projects in the network, and it’s not just about our projects, it’s about other people as well.So I think that’s really probably my proudest accomplishment to date.

Eric Ramos:

Yeah. So is EMPHARM-NET… It’s EM, right?

Brett Faine:

Yeah.

Eric Ramos:

EM. Is EMPHARM-NET just a place where people can come work on their projects? Can you tell me a little bit more about that?

Brett Faine:

Yeah, that’s a good question. Megan, she knows a lot of the people out in the world. She’s really good at networking, and so we reached out to people who we’d seen publish to see if they would want to join a network. And so the way it’s structured is that the first project we brought to the table and said, “This is the project we’re going to do.” But after that we have lab meetings two to three times a year where our other investigators will bring their projects to the group and will pitch it and say, “Hey, what do we think about this? Is it feasible? Is anybody interested? Is this what you’re seeing at practice at other institutions?” Because sometimes what happens is you practice at your own institution, you think everybody else in the world is doing the same thing, when in reality they’re not. So really we foster that building.

Brett Faine:

And so we have projects that are in different phases, and Megan and I, we try to be help push those projects along as well. So yeah, it’s just a building of projects within our group. And we’re always looking for outside investigators. You have to show that you’re going to get the work done as well.

Eric Ramos:

I know we touched a lot about the type of research that you both are doing right now or the type of work that you’re working on. What is some of that research that you guys are working on for people who may not know about your careers and what you’re currently working on?

Ken Saag:

Well, we have a mix of things. We have a center grant from the Arthritis Institute focused on gout and hyperuricemia, and it has some translational science studies in it that are being done nationally, both at our institution and we have collaborations in San Diego and Boston with other investigators. One of our studies, for example, is looking at how to improve the quality of care for patients with gout who come to the emergency room. Glad Brett is here. And we know that a lot of people, particularly people that are under and uninsured, when they have a gout attack, they don’t have a primary care doc to see, so they go to the ED and they get seen there. But then often there’s not appropriate follow up and they get into this cycle and this pattern, and ultimately, while most people think of gout as just a mildly disabling thing, it can actually lead to significant morbidity and even heightened mortality.

Ken Saag:

So we’re working with navigators and we’re working with an idea of storytelling, narrative communication, testimonials if you will, as a way to, in the ED, communicate to patients using stories of people that look like them and maybe are similar age on video clips that are delivered on an iPad in the ED in a group that gets randomized to that arm of the study. And seeing whether that, coupled with patient navigation, might result in better outcomes. So that’s just an example of the sort of behavioral intervention research that we’ve been interested in, and we apply it in gout, we might try a study in osteoporosis. We’re working out and putting together a large pragmatic trial of trying to improve care in osteoporosis, another area where therapies are underutilized. The fun part of all of it is the teams, working with really great people who are committed and have innovative ideas and lots and lots of energy to do this sort of work. That’s made it fun.

Brett Faine:

Some of the work that I’m involved in right now, so there’s another network, EMERGEncy ID NET, and that was the network I mentioned when we were talking about the COVID research. And so we’ve done some really pretty cool stuff, looked at vaccine effectiveness, we looked at does PPE work? This was very early on when we didn’t have vaccines, so that was the pivot. Am I interested in continuing COVID research for the long term? But I’ve been a part of a lot of unique projects. I was a site investigator for the CODA trial, which was looking at appendicitis patients, whether you could just send patients home with antibiotic therapy versus an appendectomy. And turns out you can do that, and so that was a big paradigm shift. One of the things that I’m personally focusing my grants on is urinary tract infection. So we’re comparing certain antibiotics, durations, stopping rules, and things like that, so that’s really my focus, where I put a lot of energy in.

Brett Faine:

And then the other offshoot of that is looking at some of our anticoagulation reversal strategies and testing for patients who come to the emergency department. We’re trying to evaluate do these reversal agents actually improve outcomes, improve coagulation parameters. So those are, I guess, the two main areas.

Ken Saag:

Yep. So when you get old and gray like me, one of the things that you spend time doing is helping other people with their work, and that’s a lot of fun. There are some really good people right now that I’ve been reading a lot of things they’ve been writing. And we’ve got one, she’s not junior anymore, she just got promoted to professor, but one of my mentees just put together a really interesting study looking at ways to compare telehealth with usual care, and seeing whether there’s differences in outcomes and satisfaction. Then she just got a really great score on a full scale study on R01 to the NIH looking at COVID vaccination. And similar approach to what I described in the gout ED study, where we’re using stories in assisting people in getting access to booster doses, because COVID ain’t going away, and despite feeling a little bit better about it. And particularly for our patients that are on immunosuppressive drugs, that’s the big concern.

Ken Saag:

And a lot of them are particularly in places like Alabama, and I’m sure in Iowa to some degree too, where we have a lot of people that are under or unvaccinated and haven’t gotten the message. Their healthcare providers can be a trusted source of information, but sometimes it’s people they know, or in this case more of a community based approach to trying to get them to think differently about it, and hopefully avoid in the future bad outcomes, not just for COVID vaccination, but for preventive health in general.

Eric Ramos:

Yeah, definitely fascinating and also a little scary how much COVID-19 has shifted research and shifted how we think about life in general as we continue to go through what? Two and a half years now into the pandemic, I think. And it’s interesting to see, because there’s really no end in sight if you think about it, thinking about how you mentioned Alabama. I mean, in Iowa there are rural communities out there who for the majority are not vaccinated. So it’s interest to see how that’s going to continue to affect research. We’re talking about the research you are doing now, and we kind of touched upon some future work. What’s something you’re excited about or hopeful for going forward in your career and your research?

Brett Faine:

I think for me the biggest thing would be just being an independent federally funded investigator. I’ve spent fair amount of years trying to cross that threshold, and I think when I look at the pharmacy model, with clinical pharmacy specifically, we need to do a better job of modeling the medicine model, where we have people pursuing grant funding and having more joint appointments and things like that. And I think, for emergency medicine based clinical pharmacists, we just haven’t seen that. We’ve seen that with critical care and things like that, but EM, like I said, is still a pretty infant in terms of how long we’ve been around. So I want to break down those barriers, and I think that’s the biggest goal for me right now is spending all my resources or energy towards obtaining that grant funding.

Ken Saag:

A key to the long term success in this academic thing is persistence and perseverance, and it’s encouraging to me that in many areas of clinical investigation there now are added funding opportunities. It’s still exceptionally competitive to get money safe from the NIH, but there’s been a little bit of a shift in the last decade or two in recognizing the value of some of the things that we do in public health research and population based research, epidemiology in particular. And NIH is supporting it. There’s new funding entities like PCORI. There’s opportunities to work with nonprofits. There’s ways to partner more effectively with the private sector. There’s better data resources. There’s networks of aggregated data, PCORnet. Different collaboratives within the NIH that have made it more feasible to do big important studies that are interesting, and that answer questions that have great public health relevance. So that’s encouraging. Trying to align the resources is challenging and you got to really just keep knocking, and eventually, if you have a good idea and you keep shopping it around, often there’s a way to get it funded.

Eric Ramos:

Thank you guys so much for all the insight you provided throughout the interview. And we’re going to ask you one final question that we ask all our guests on every single podcast. Your response doesn’t have to be public health related or even related to your career, so it can be about anything. What is one thing you thought you knew but were later wrong about?

Ken Saag:

Yeah, that was a tough one. I saw you getting ready to ask us that and that’s hard. I think, and this is a little tough to say in a way, but the thing that has struck me is that it doesn’t necessarily get that much easier over time. It’s tough. It’s tough to do the work we do in research, but what does change is despite having, particularly if you’re on soft money, which is what research funding largely is, some people may have support through endowments and other things, but most of us support ourselves through grants and you’re competing all the time. And you’re really only as good to some degree as your last funding. There is some value to cumulative success, but it’s modest. But you become more used to it and you become more confident and you become more assured that you’re going to find a way to do it and that you’re going to find a pathway, and that if you’re persistent, it’s going to work out. And there’s different ways to go and different paths that you can take. And it’s really interesting to see even how some people reinvent themselves over time in their careers. So there’s usually a pathway, and it becomes more routine. We have a big grant due today. I’m out of town. I’ve got a great team working and I know it’s going to get done. I know it’s going to go in, and we’ll see how it goes. And that’s the thing that changes, although it doesn’t necessarily get a lot easier.

Brett Faine:

Yeah. I think you’re right, though. You mentioned persistence. I think that’s a big thing too, but yeah, once you start to learn the pieces of the process, it gets easier. I remember my big first big grant. It was a PCORI grant, and I remember looking back about the energy it took me to get that thing across the finish line was just astronomical, and now I’m not doing this, that was a huge grant, but now putting in fairly large grants and it just seems to be more efficient. Over time I think you just have to stay with it, and once you get into that groove, you can make it happen. I haven’t been there yet. Hoping to at some point. But it does become more efficient and easier to do.

Eric Ramos:

Yeah, I’ve never had to apply for a grant just yet, so I’ve heard it’s a beast. So props to you both for all the hard work that you’re doing with in your careers and within your industries. Good luck on your grant proposal. I’m sure your team has it well under control there for you. But well, thank you so much for being here today. Congratulations on your Outstanding Alumni Awards. My name is Eric Ramos. I’m joined here with Dr. Kenneth Saag and Dr. Brett Faine. Thank you so much. Have a great day.

Brett Faine:

Great. Thank you so much.

Ken Saag:

Great to talk to you.

Brett Faine:

Yeah, thank you.

Eric Ramos:

That’s it for our episode this week. Big thanks to Dr. Kenneth Saag and Dr. Brett Faine for joining us today. This episode was hosted by me, Eric Ramos, and written by our director, Anya Morozov, and edited and produced by me, Eric Ramos. You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts, and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues, friends, or anyone interested in public health. Have a suggestion for our team? You can reach us at CPH-gradambassador@uiowa.edu. That’s CPH-gradambassador@uiowa.edu. This episode is brought to you by the University of Iowa College of Public Health. Until next week, stay healthy, stay curious, and take care. Eric out.