How UCLA Health physician-scientists are making things better
‘Cultural North Star’ inspires researchers at the David Geffen School of Medicine at UCLA
Update: On March 17, 2022, Dr. Carol Mangione was named chair of the U.S. Preventive Services Task Force.
A guiding principle of the David Geffen School of Medicine at UCLA approach to leadership is “making things better.” During a Dec. 14 webinar, four UCLA Health physician-researchers inducted into the prestigious National Academy of Medicine shared how they are doing just that.
Along with “do what’s right” and “be kind,” “make things better” is among the pillars of the medical school’s Cultural North Star framework, said Steve Dubinett, MD, interim dean of DGSOM.
It’s a pillar that the four featured physicians are bringing to life in their work.
An addiction psychiatrist, cultural anthropologist and associate director of the Center for Social Medicine at DGSOM, Dr. Hansen explores the intersection of opioid addiction, race and ethnicity, and social determinants of health.
Dr. Hansen became interested in addiction as a field of study early in medical school and has tracked the racial, economic and social factors influencing the opioid epidemic.
This research informed her work in developing translational social science, which aims to improve clinical practice by incorporating knowledge of the social determinants of health and other social processes that affect medical treatment and health outcomes. In day-to-day practice, she said, this might look like forming partnerships with community organizations that serve marginalized groups or providing help in navigating systems such as Social Security.
“The mission of our research theme is to really establish translational social science in the study and delivery of equity-centered patient care,” Dr. Hansen said, “and build an inclusive, multidisciplinary, scholarly environment at UCLA.”
Division chief of General Internal Medicine and Health Services Research, Dr. Mangione is also vice chair of the U.S. Preventive Services Task Force, which makes health-screening recommendations for all Americans.
When it comes to making things better, Dr. Mangione has focused on the powerful impact of incorporating patient preferences into shared decision-making about their health. To illustrate how influential this approach can be, she discussed pre-diabetes interventions.
About one in three American adults — around 84 million people — have pre-diabetes. About 9 million of them will end up with type-2 diabetes within three years. However, ample research shows that if people could lose about 7% of their body weight and log the equivalent of 30 minutes of brisk walking five days a week, they could reduce their risk of developing diabetes by 58%.
Only a tiny fraction of people actually follow through with these lifestyle changes, Dr. Mangione said.
It’s not just about patient motivation, she said. A UCLA study found that people in neighborhoods with the highest rates of pre-diabetes lacked access to healthy foods and safe spaces to exercise.
Shared decision-making can help, even when it appears that options are limited. It’s “a purposeful way of educating patients, assessing their values and preferences and helping them make informed decisions,” Dr. Mangione said.
She and her team studied how shared decision-making could affect diabetes prevention. They found that by talking with patients about their personal preferences, discussing their options and helping them make informed decisions, participation in diabetes prevention programs increased from less than 4% to nearly 40%.
“Shared decision-making needs to be available for all UCLA Health primary care patients who have pre-diabetes,” Dr. Mangione said. “And, more importantly, we need to engage our community partners to secure the needed resources to spread diabetes prevention to the Los Angeles safety net, where the need is overwhelming.”
A health policy leader and executive vice chair for equity, diversity and inclusion in the Department of Medicine at DGSOM, Dr. Norris has been working to promote partnerships between academia and communities for nearly 30 years.
“I believe in a society grounded in equity and justice,” he said.
That abiding belief has inspired Dr. Norris to connect with underserved communities throughout his career and to encourage community involvement in scientific research.
“That’s important, because when we’re thinking of solving problems in a given community, individuals from those communities have really important insights about those problems and really important insights into the potential solutions,” he said.
One example of this approach was with Stop COVID-19, a program funded by the National Institutes of Health. More than 100 community partners came together with academic leaders at UCLA to address pandemic challenges in low-income and racial and ethnic minority communities.
“At the time it was for education and participating in trials,” Dr. Norris said. “Subsequently, it transformed into vaccine equity.”
Some of these community partners were credited as coauthors on the resulting scientific papers that were published, he said.
To ensure all stakeholders are represented, Dr. Norris said, he regularly asks himself, “Who is not at the table?” Then he invites them.
Dr. Rando recently joined UCLA Health as director of the Broad Stem Cell Research Center, where curiosity is a driving factor in the team’s research. “One of our core missions is to support curiosity and discovery, and to take those discoveries from the laboratory to the patient,” Dr. Rando said.
He pointed to the accomplishments of Don Kohn, MD, whose pioneering work has led to the successful treatment of more than 50 patients with “bubble baby disease” (severe combined immunodeficiency, or SCID).
“This is just the beginning with the center,” Dr. Rando said. “There are a whole variety of diseases — ranging from immunologic disorders to neurodegenerative disorders to cancer — that are in this pipeline for first in human trials, novel stem cell therapeutics.”
Other research is looking into what controls youthful healing and how to potentially capture it in therapeutic form.
“We’re hoping that our curiosities about aging and stem cells will someday lead to therapies that will allow tissues of older individuals to respond to damage, whether in the setting of injury or disease, to respond as effectively and efficiently as younger individuals,” Dr. Rando said. “It really is the promotion of curiosity, and the translation of discoveries into therapies that make things better, that contribute to making our institution a true Cultural North Star.”
Learn more about the David Geffen School of Medicine at UCLA’s Cultural North Star program.