Sanjay Basu on his NIH award, and the importance of risk-taking in research

In September, Sanjay Basu, MD, PhD (assistant professor, Stanford Prevention Research Center), received a call from a program officer at the National Institutes of Health (NIH) informing him that he had received the New Innovator Award, a five-year, $1.5 million grant designed to fund high-risk, high-reward research.

“It was thrilling,” Basu recalls of the initial phone call. “And I thought they had made a mistake.”

As funding rates decline, many physician scientists often find themselves in a never-ending cycle of grant writing and revising. That’s why awards like the NIH grants are so valuable: They provide young investigators with enough support and flexibility to build a team and pursue their research.

Basu has long been contemplating the social and economic forces that shape our society, and how “various policies can help impact that.” He plans to use his funding to investigate, among other things, how public health and disease prevention programs can better prevent chronic diseases that disproportionately affect low-income populations globally.

He discussed his NIH award, detailed his future plans, and shared his thoughts on the importance of risk and failure in research in a recent interview.

Q: You came to Stanford in 2012 from UCSF. What drew you here?

When I finished my medical residency at UCSF, I began to look around for local jobs in the Bay Area. I knew that I wanted to continue research, and Stanford’s Department of Medicine seemed particularly interesting because there were a lot of unique people doing crazy weird things - and that appealed to me.

It seemed like a place where people were allowed to take a lot of risks. And some of my intellectual heroes – like John Ioannidis who runs the Stanford Prevention Research Center – were around. John has always been known as being somebody who's willing to be a critical scientist and think really deeply about data in a way that other people don’t, and his work had always inspired me. Once I saw that there was an opening in his department in particular, I couldn't help but jump at it.

Q: How did you first become interested in epidemiology and, more broadly, public health?

When I was in medical school, I began to look at some of the initial work that was attempting to explain disparities in health across different states.

Perhaps as a naïve medical student I had assumed that a lot of disparities could be explained by differences in health care insurance, or the quality of doctors and hospitals. Once I began to learn a bit of statistics, I was surprised to find that the actual differences could not be explained by these common factors.

I wanted to understand a little bit more about the ways in which various societies had actually been successful at reducing disparities in health, and I became interested in epidemiology because I found that so little of it could be explained by medical systems, technologies or advances.

Q: This award seems unique in the funding world, in that it supports high-risk, potentially high-reward research. How did you feel when you first learned that you had received the award?

It's incredibly intimidating in the current environment to be a junior faculty member because the conversations around campus, both here and everywhere, are understandably about how low the rate of successful grant funding has become. No one grows up wanting to be a scientist in order to answer minimally interesting questions and contribute minor little discoveries to the world, with the hope that they'll be safe and easy to publish in a paper.

We all go into science hoping to ask very fundamental, big questions that will hopefully improve health in a bigger way, but there's no real incentive to do that when taking a risk and doing something that might fail is considered a bad thing from the perspective of a grant application. So this is a truly unique opportunity because failure is not discouraged and is not so terribly feared but is understood as inherent to any successful and meaningful scientific endeavor. I think it would be really hard to imagine making serious progress in science of any kind – whether it be epidemiology or laboratory science – without having a serious willingness to fail a lot.

Q:  How are you planning to use your funding?

The major research that I do here is in cardiovascular disease prevention, particularly in trying to understand how large structural factors like the food policies that we choose ultimately come to impact rates of heart disease and stroke. For example, we have about 1 in 7 Americans participating in federally sponsored nutrition programs – like the Food Stamp program – yet there are only a few studies exploring how well that program actually improves nutrition and impacts disease.

One of the things I hope to do with the award is collect and link some of the first data sets that could help us study how and why these types of programs influence health over the course of life from early childhood to death, and how variations in how these programs are run may actually make a difference in how well they prevent disease. One recent discovery from some of our preliminary work found that when people get support for purchasing food once a month, they often spend it on packaged foods and things we would consider less healthy; but if they get the same monthly amount and distribute it once a week, they purchase a lot more fruits and vegetables and other perishable type foods that are associated with improved health outcomes. So, it's a strategy of changing how people react to the same amount of support by delivering it in a different way.

This award will help me gather a group of like-minded people together to work on these types of problems in a cohesive way. It will allow me to attract some really talented postdoctoral fellows – from diverse backgrounds like epidemiology, economics, and statistics – to work together to understand some of the ways that social programs influence health disparities.

Q:  What are some immediate next steps for you?

One of the joys of Stanford is having an easy time attracting talented people. I'm currently gathering together three people who are interested in collaborating on this project as post-docs, and we hope to obtain at least three long-time data sets that provide detailed information on people's exposures over the course of their lives, which programs they participated in, and their health outcomes. Then we’ll try to understand how those are all linked to one another, and implement new methods for understanding how variations in those programs could alter and improve their health.

We’re also trying a few new methods from the fields of economics and statistics, as well as adopting new methods from the field of computer science in order to integrate those strategies into some common resources, such as publicly available data sets and new statistical methods for analyzing data.