Andrew Trister, Deputy Director of Digital Health and Innovation, Bill & Melinda Gates Foundation, Reflects on a Meandering Path to the Field
Dr. Andrew Trister, Deputy Director of Digital Health and Innovation at the Bill & Melinda Gates Foundation, recently spoke at UW as part of the university’s Global Month. His discussion, titled “How Can We Achieve Multidisciplinarity in Global Health?” drew a wide array of students, faculty, staff, and others committed to global health. The discussion paired a presentation by Trister with a Q&A session and discussion.
Trister began this undergraduate-focused event by encouraging students to maintain their academic curiosity, as new innovations often come from unexpected or unconventional paths. After practicing medicine at UW for five years – starting as an intern in internal medicine and eventually becoming a chief resident in radiation oncology – Trister took a job with Apple. Using his background as an engineering student (Trister studied Computer Science and Engineering at the University of Pennsylvania before entering the workforce), he led a team that began building health-related products that combined his engineering background with his medical work. This interest in medicine and finding creative, scalable solutions in global health began when Trister was a child and his cousin was diagnosed with cancer.
“This was the very first time I understood what it meant to be sick,” Trister said, showing a photo of him and his cousin from their youth. “It really meant a lot to me to dedicate myself to helping people.”
His multidisciplinary path began during his time at the University of Pennsylvania, taking interest in artificial intelligence, neuroscience, and math. “There was no direct connection between what we understood in neuroscience and what we understood in artificial intelligence. So, what I ended up doing was working on two projects at the same time. You have to understand full systems to really make an impact.”
Eventually this spawned an interest in neuromorphic engineering, but when his mentor left the university, Trister shifted his focus toward HIV. Looking for a breakthrough, he began modeling the virus to try to gain an understanding of how it works.
“It turned out that modeling disease was a powerful thing. We were able to make predictions before there were any drugs and validate them in a lab.” Modeling HIV then reminded Trister of why he started this career path in the first place, and he soon started similar work on cancer, exploring methods of data collection through modern digital technology. This information was presented by Apple as ResearchKit, a creation that would change the way data is collected for medical research.
“If you had a phone in your pocket, you would be able to participate in medical research,” Trister explained. “You didn’t have to go into a clinic. You could just download an app and start doing measurements. This took off. We ended up having 150,000 people participating in those first studies within months.”
Using some of the same slides he showed at his UW discussion, Trister went to Apple and asked for additional funding to run a clinical study, which in turn led to a job offer. “It was completely out of the blue, not at all in line with anything I thought I’d do in my entire life, despite the fact that I was an engineer,” Trister remarked. “We thought maybe we could start looking at things related to health, not just wellness. Can we figure out things that might actually indicate a condition?”
It was around this time that Trister said he had an epiphany about the future of medicine, realizing that these devices and software could completely change the way we understand conditions, and should be available on a universal scale. This is how he ended up coming to Bill Gates with a presentation on digital health and cultivating these new, multidisciplinary approaches that have the potential to change global health forever.
Q: Broadly, how do you see the role of multidisciplinarity in global health?
A: There are many, many barriers to having any of these things work. It requires an extremely broad knowledge base and teams of people coming at problems from completely different lenses. Take advantage of things. Go to lectures outside your own discipline. Find friends that have ideas totally outside your own while also sharing your passion. Tell them what you’re interested in because you never know what idea will come out of that. Ensure that you have the most basic building blocks to build on top of. I knew that I had to go and learn math, and the same is true in public health. The passion may be about the people that you will help, but understand how you can construct the tool kit to help you achieve those things.
Q: How do you envision the future of digital global health?
A: In the beginning, we will focus on software and anticipate leveraging hardware that is ubiquitous. In the history of medicine and epidemiology, there’s a fascinating thing that occurred. At the turn of the last century, there were many different ways to practice medicine. As allopathic medicine rose to prominence, there was a schism with public health and epidemiology. There was no longer a sense that the doctor was taking care of a population – there was an emphasis on the science. Even in my time in UW Medicine, I had to remind students that we don’t treat an image, we treat a person.
What we’re proposing in our strategy is to leverage technology to bring back all of the data that epidemiology and public health have been developing, and applying it to the individual- in effect to use one person to inform all of the care given to everyone else and vice versa. To facilitate this vision we are working to ensure that any device of software that might collect data in low- and middle-income countries to build interoperable solutions. We do not think that any one company should be the sole aggregator of data.
Q: How do you suggest we navigate this journey and overcome barriers of government and health care systems to get the technologies to the patients who need them?
A: People anywhere on Earth have similar wants, fundamentally. Recognizing and honoring that will help us arbitrate what’s good and what’s bad. The model here is going to be showing communities that these technologies work. It has to be organic and driven by people who are going to get helped. I think the only way to do that is to try and show that it does in fact work. If you can show that things really did improve, it wouldn’t matter to the public health official if they’re going to buy it or not. People are going to start demanding it. One of the most sobering statistics I’ve learned is the amount of out-of-pocket expenditure. Even for people living on $2-4 dollars a day, 40 percent of their healthcare expense is paid out of pocket in a private health system. Those 40 percent are consumers who are going to choose value and choose what is efficient. The recognition that people can make choice must be embraced, but it will be a long road to complete adoption.