Dr. Ingrid Katz is an Associate Director at the Harvard Global Health Institute, Associate Physician in the Department of Medicine at Brigham and Women's Hospital, Assistant Professor in Medicine at Harvard Medical School, and a research scientist at the Center for Global Health at Massachusetts General Hospital. Ingrid’s research focuses on the social determinants of health-seeking behavior among people living with HIV in South Africa. Ingrid talks with Valerie and Carly about biking across the country after college to raise awareness about HIV, her interest in the “complexity of the human condition”, the value of interdisciplinary teams, her many work hats (doctor, scientist, teacher), and being part of the first openly gay couple to match at a Harvard-affiliated hospital.
Read more about Dr. Katz’s work here: https://globalhealth.harvard.edu/team/ingrid-katz/
Follow her on Twitter: @IngridKatzMD
Access recordings from Dr. Katz’s class (Confronting COVID-19: Science, History, Policy) here: https://globalhealth.harvard.edu/domains/pandemics/courses/
Watch Dr. Katz chat with the Time for Kids reporters about COVID-19 here: https://www.timeforkids.com/g56/ask-the-expert-katz/
I'm Valerie Earnshaw
I'm Carly Hill
And this is sex drugs and science.
So we're back
We're back for just a short winter season. We missed you so much, couldn't stay away. This is a summer podcast, but we wanted to bring you just three episodes to keep you warm over winter, especially, you know, congratulations on surviving the fall of 2020. This is a little treat at the end of that. So, so we're going to bring you three episodes in this mini season, and our first episode is with the doctor Ingrid Katz. Ingrid is an associate director at the Harvard global health Institute. She's an associate physician in the department of medicine at the Brigham and women's hospital and assistant professor in medicine at Harvard medical school and a research scientist at the center for global health at Massachusetts general hospital. So Ingrid is a lot of things.
Is that all?
Ingrid's research focuses on the social determinants of health seeking behavior among people living with HIV in South Africa. So we hope that you enjoy this conversation with Ingrid as much as we had having it.
Dr. Ingrid Katz. Thank you so much for joining us on sex, drugs and science. We are super, super duper thrilled to be talking with you. Yes.
And so happy to be here. Yeah.
You were like probably, you know, you were like top of the list. I think I even sent you an email when I had this idea and then COVID happened and I just felt like I could not bother you with you know, sitting down to record with us because you know, everything got so busy, so we're really excited to connect for this, you know, special, short winter season that we're releasing
I love it. And I've been looking forward to this all week. Thank you guys for having me
Same here. All right. So, you know, in honor of the theme of the show, sex, drugs and science, we wanted to start out with some of the work that you do within HIV. So for folks who aren't familiar HIV, it's a virus that attacks your immune system and it's mostly transmitted through bodily fluids. So you can get it if you're having sex without a condom or through injection drug use, before we dive in any deeper, is there anything else folks should know about HIV before we get into your research? Because you are the person with an infectious disease training and I am not,
No, I think you've covered the main modes of transmission. I think, you know, back in the eighties, when we first learned about HIV, there was also the risk of acquiring HIV through blood transfusions, but now, you know, we successfully screened for that. So that really isn't a risk factor anymore. So I think you've nailed it. Okay.
Okay. Great. Well, that's good. That Seth Kalichman, you know, from 10 years ago, my HIV classes would be very proud of me then I guess
(Laughs) Definitely proud of you for more things than that.
Oh yeah. Maybe. so a lot of your research focuses on HIV medication specifically. So a lot of what you've done is sort of try to understand why people take or don't take their medication. So could we start off by asking why is HIV medication important? What does it do in the body?
Sure. So, you know, we're very fortunate with antiretroviral therapy, which is what we refer to as art. That it's actually really been a tremendous breakthrough. And, and this is a kind of a combination, what we call it, cocktail of medications, usually three medications that are given they can be given in a single pill. Sometimes they're taken in multiple pills and they're really life sustaining medications for people living with HIV. And the kind of third piece of the wheel that was really the breakthrough happened in the mid nineties. I will never forget when I was at the big AIDS conference up in Vancouver in 1996, which shows you how old I was. I'd like to imagine I was two, but I wasn't. When they announced on the big stage that they had something called a protease inhibitor, which was a new type, a new class of medications that was going to be added to the cocktail and no longer would HIV, an HIV diagnosis be a death sentence. And this was really revolutionary. And really, I remember that as exactly the moment where there was a fork in the road and we made a huge turn. And ever since then, it's just been about building on those successes,
Such a big moment in time. I mean, before the mid nineties, HIV was just, it was a death sentence. And then afterwards with these medications, I mean, you know, stories of sort of like people coming back from near death. And now we have people who can live a full and healthy life, you know, with HIV. So it's, it's, you know, completely different pre 90 pre mid nineties to post mid nineties.
Yeah. And anyone who lived through that time has that appreciation that it was not that way in the eighties and early nineties. And, you know, obviously many lives were lost. So it's, it was really a transformative moment for people who were working in the field of HIV and certainly people living with HIV. It was, it was transformative,
So we hear a lot down in Delaware about U equals U also. So HIV medication can be really important for people living with HIV to keep them healthy. But then there's this idea also about undetectable equals untranslatable and we know that has to do with the HIV medication. So could you tell us a little bit about that as well?
Sure. So there were a couple of big studies, there was first a bunch of observational studies that set the feel that set the stage, sorry for this. And then there was a big randomized trial that looked at the impact of people being on antiretroviral therapy and what we call suppressing their viral load, which basically means that the amount of virus that is circulating in their body is basically undetectable. And if you can be on your medications and it's successfully suppresses your viral load, then you essentially cannot transmit the virus to, for example, a sex partner or someone maybe that if you were for example, sharing a needle with someone injecting drugs or something like that. So it was an extremely important finding for the field because we essentially realized if we can just get people on treatment, not only is it critical for their own health, but it prevents transmission to others. So it, again, another groundbreaking moment for the field.
So we have These amazing medications, super medications. They can, you know, turn a very scary illness into a chronic illness and it can also protect other people by preventing people from being able to transmit it. So a lot of your research then has looked into given that we have these meds, what are reasons why people don't start them after they get an HIV positive diagnosis. And then also I think a little bit like why don't people stay on their medication? So what's some of the, what's some of the things that you have found in terms of sometimes we'll call this, you know, barriers to adherence or barriers to medication initiation or starting medication.
Yeah. So maybe it's helpful to put this in the context of the story of my journey around this. I mean, I was involved in, in some of this work back in the early nineties way back when, I don't know if I ever told you this story about, but when I graduated,
No I need to hear it. Okay. Yeah.
When I graduated from college, I had this big ambition to bicycle across the country for reasons that are still not totally clear to me.
I'm really, really excited right now to hear how we're going to get that Ingrid bicycle across the country, to English, Ingrid studies, HIV, HIV care. So, okay. It's totally right. I'm here for this.
This is how my brain works. So I felt like it was important to do that. I, I, I don't know. I wanted to do it to raise money for HIV research and advocacy. And so there was yeah.
You were already interested in HIV before you break out the bicycle. Okay.
Yes. Yes. The two were coming together. I mean, it was the late eighties, early nineties that's I graduated from college in 93. So, you know, it was a time where there was certainly a lot more national awareness of it, of HIV. And there was this group called bike AID back in San Francisco and the era of live AID, which again, maybe some of your listeners don't even know, cause that's like really a distant reference, like when the dinosaurs roamed the earth. But that was a big thing. You know, these big events. And we were a group of there were probably about 80 bikers coming from different routes that were going to come across the country. And we were raising money for HIV research and activism. And then we were stopping in towns all the way across the country to kind of connect with people, you know, person to person.
It was very much kind of this person to person movement. We were going to, we had this sag wagon or band where we brought condoms and we brought, you know, all the stuff, right. And we were like this little scraggly group of bicyclers. Our group had about 20, you know, of kind of these urban either kind of East coasters or San Francisco kids who were going to bike across country and do good things. That was our goal. And you know, it was, it was obviously an ambitious goal to think that we could change you know, the game at that point. But I think we felt like we were part of a movement. And I think that time, you know, the late eighties, early nineties, there was so much activism around HIV. And honestly, the people I knew living with HIV would have given their left arm to have successful treatment to, you know, live, I mean, people were dying.
It was, it was a time of tremendous pain in the community. And that's where Act Up, came from. That's where a lot of the social movements grew out of the gay men's health crisis in New York city. People were deeply connected to this work. I mean really in a transformative way. And I think we owe a lot to that community of activists. And so, you know, fast forward now I go get a master's in public health. I go live in a lot of different places. I go to medical school and train in infectious diseases. And I'm now in Sub-Saharan Africa, we're really the heartbeat of the pandemic still is living. And I'm working in South Africa, which still has the highest number of people living with HIV in the world. There's about 8 million people there living with HIV. And at that point now we're many years later kind of 2008, 2009, they president's emergency plan for AIDS relief, which was actually started under George W. Bush spearheaded by the now famous Tony Fauci. He was always famous before, but now he's really famous in terms of this work. You know, the whole thing,
Everything. Yeah. Had really invested in getting treatment to Africa that had been the big sticking point in kind of the early nineties, is that there was not treatment available in Sub-Saharan Africa. And there was clearly a difference in what was happening for people in the United States, where it really had switched to becoming kind of a, something that you would take medication for. And you'd be living with HIV, to people, to having still a death sentence. So that had all come to pass. And I was now in South Africa and I was like, this is great. We now have treatment in South Africa. It's free, it's available. It's at these very nice clinics that PEPFAR is funding. So lots of people should be here. This should be like, people should be lined up around the block. And I go into where my colleagues were based in Soweto (Africa) and I'm finding out actually that people are not starting treatment.
I mean, not the majority, but certainly not the minority. And, you know, people were kind of telling me about this in this of, yeah, it's so frustrating. You know, when they finally do show up their CD-4 count, which is a measure of their immune system is really low, which means that the virus has kind of beaten down their immune system and they keep, and they're going to get really sick and some will die. And we were so frustrated with that and I'm kind of sitting there scratching my head. I was like, I don't understand. And I think this is actually one of the benefits of being an outsider. I've struggled a lot with being an outsider in global health in terms of, you know, neocolonialism and the context of me working in Sub-Saharan Africa, for example. And I would say the time that I feel like I bring the most is actually that outsider view where I'm, I'm having a lot of cognitive dissonance around this and the same way someone who would come into my system from the outside and say, why is it this way?
And I'm going well, I don't know. It's always been this way. You can kind of come into a space. That's not your own and say, well, wait a minute. Does that really add up to you? Why is that? And so that's what happened for me. I kind of was the light bulb was going off. I was saying this isn't making sense to me. I thought the whole goal was just to get treatment here. And once treatment was available, everyone was going to start it and they were going to stay on it. And it was going to be this miraculous change because I remember the people back in the late eighties and nineties who would have given anything to be on treatment and have it saved their lives. So it was just, it was actually the full arc for me. And it made me realize I wanted to study this and understand why that was happening and maybe try to come up with some interventions to help people see the benefit of being on treatment.
So such an interesting story. One of the things I was wondering about also when I was looking over some of your background was at what point does Dr. Ingrid Katz decides she want to do research and, you know, become a scientist because you know, getting trained to be an MD is so much work, and then you decide at some point, Oh, well, I also, I want to add science to the mix of it and to, you know, not everybody does that. So is this also, you know, what I'm hearing in this story is you, you had this observation, you wondered what was happening and then you wanted to study it to figure it out. So is this, was this a moment in time when you were, when you kind of delved into science a little bit or were you already on that path anyway?
No, I, I, as you can probably tell from my narrative so far, it's rare that I actually have a really long-term perspective only in the retrospect where I go, Oh yeah, that's the arc. Okay. That's good. And I want to make that really clear to people who are students or, you know, junior faculty or whatever that it's so rarely kind of plays out the way you it's going to play out. And, you know, fundamentally at the end of the day, I just followed my passion. I was super lucky that my mentor, David Banks, Berg showed up at Harvard around the time I was getting interested in thinking about pursuing a research career. And I knew it wouldn't be kind of a basic science career. My mom is a basic scientist, a hardcore, basic scientist. I, I love that she does that knew it was not for me. And my dad is actually a physician, a full-time clinician. I mean, he's retired now, but I knew that wasn't for me.
That's amazing. You Come from a, from a site, you know, your parents are a scientist and a physician here you are. Okay. I'm sorry. Continue. I got it. Yeah.
Yeah, no. And, and you know how kids are, it's like, no, I'm not going to be you. Let me be somebody else.
Definitely so different. And you can tell I've really strayed far from that, but,u
Thank god you did
Gosh, no, I don't. I feel like it's just, it's just something that presented itself and, and David is fundamentally interested in behavioral science question. So he basically created a space for a group of us here at Harvard to start to kind of think about questions like this. And I really didn't know what I was getting into. I mean, I I've always been someone who's been very focused on the narrative arc and both my wife and I write-- Have written a lot together about kind of the complexities of the human condition. And so I knew that was something I was drawn to and felt passionately about.
I knew I was also drawn to public health, so I knew it had to be within that context. I had some, you know, I had a master's degree in public health, but, you know, that's just kind of like not nothing compared to you PhD folks, but it gave me enough of a toolbox to know that I could ask questions and try to work with a great team of people to try to answer them. And that's fundamentally what it was about. And then yeah, it was the spark of the question and I said, God, I really want to help figure this out. And not only do I want to help figure it out, but I want to help try to figure out ways to address this because I want people to be able to benefit from treatment because it is so lifesaving,
I'm loving this, I idea this like spark thing that happens. Cause I think I'm at a--not to derail us too much for me to beat, but I think I'm at a moment where I am seeing where I'm trying to decide what's my next step for grant writing and other things. And there is just this stigma, the stigma finding that if you look across studies, it's really inconsistent. And I think I'm, I think I might have a sense of what's going on, but it's the same moment of like, what is happening here and just kind of like taking a step back and observing and, and being like, no, I think I to, I want to move into that to really try to, to try to figure it out, figure it out. And I kind of joke with some of my graduate students now that when you, when you have that sort of drive, whether it's looking at, you know, why aren't people connecting on medication adherence or for me just like looking across this cluster of studies and being like, what is happening here?
That's I think how, you know, like you're a scientist, like you want to go, you want to go jump in, you want to answer the questions you want to like, do something about it if it's a problem. So so that's really neat. Okay. So you take this step, you decide that you want to study it, you got some ace mentorship and support happening. And so then you start to run some initial studies. And so what do you find is going on? That's keeping people from starting or staying on this, you know, really great medication.
Yeah. So again, I mean, I think it's the complexity of the human condition and I think that's, what's so fascinating. You know, I do think as a physician, our training does not unfortunately incorporate that enough and yet it drives so many of the health outcomes and the disparities in health outcomes that we see. And it's all I call it, all this stuff, you know, it's like you go into the soup pot and it's like all there, right? It's stigma of course, your area of expertise and it's poverty and it's food insecurity and it's racism you know, complex issue in South Africa, but still absolutely there, it's all of the stuff that has accumulated over time. And so I think, you know, in, in kind of diving into this, you realize people aren't making their decisions in a vacuum because I think as, as physicians, again, our training, we're so driven by the biomedical work and so driven by the evidence everything's gotta be evidence-based right.
And then we presume, I think at some level, if we present people with the data, they're going to make a rational choice, it's going to be extremely rational. They're going to weigh things exactly evenly and decide on the rational solution and how fascinating and confusing to us when that doesn't happen. And yet it happens all the time. In fact, even myself as an infectious diseases, trained physician, if I get some antibiotics for a UTI and I'm on day four of five, and I know I'm supposed to finish it and I'm kind of feeling fine, I'm like yeah I'm kind of done, but the data would not tell me to stop. The data would say to continue so that I don't develop antibiotic resistant bugs. And so I think it's fascinating. It's truly what makes us the complex beings that we are. And so, you know, when you unpack it all, it's all those things.
And I think what was perhaps, and none of that was surprising per se. I mean, the initial finding was super surprising, but then once I kind of unpacked it, so yeah. Yeah. I think what was perhaps most surprising to me as we kind of walked through this arc together and you know, I I've, I still continued to work on this issue now. Hm, 11, 12 years later is that as things have changed in South Africa over time. And initially when I was there, it was very restricted who could get access to treatment. It was basically the sickest people, right? That was, that was all they had. So you had to have a very low CD-4 count below 200, which means basically an AIDS diagnosis to, to qualify. Otherwise you have to wait in the queue until you got that sick, which is a very challenging message and not one I would espouse, but that's what it was.
And now that things have changed so much that treatments available for everyone living with HIV, what is so interesting to me is that the people who struggle are the, I always say to people who struggle are the ones who struggle. And that sounds so obvious, but it turns out there was a lot of people who hypothesized, "Oh, once medication becomes available to everyone, then the people who are doing well are not going to start because they feel good." Initially, you don't feel so sick, but it turns out that's not the case. It's the people who actually are not doing well, who often struggle to initiate treatment. They're the ones who have struggled with the healthcare system. They've struggled with the stigma. They've struggled with disclosure, they've struggled with all these other compounding factors that make their lives hard and complicated. And so that's been a really interesting narrative arc for me to look at and try to figure out what are we doing to support people who really struggle? What are the ways that we could be addressing this better? And that's obviously that's a global phenomenon. It's not just in Sub-Saharan Africa. We should be, you know, and we are, there's lots of people who are focused on that, including you in the U S who are thinking about this and trying to really unpack these issues, because I think that's at the core of what is, you know, inherently challenging here.
It's so... This like the people who struggle are the people who struggle is an interesting observation. Well, in part, because you know, it's election season, we're thinking a lot about policies right now, and we're also thinking a lot about like systemic issues and like, how are things baked in to the systems and our, you know, in our structures and organizations and, you know, I think a lot of people think like, okay, so if we just had like universal health care, or if we, or like in South Africa, like just everyone has access to this medication, it should, it should clear up. So it's interesting to have these examples of, okay, so we take away some of these like systemic barriers, or we take away some of these like overarching things and, you know, a lot of people that are benefited, but then they're still like, you know, this complexity, as you say of the human condition, like there's still this, like, you know, people who are struggling or this messiness, then that we still need to figure out and, and help people with.
Yeah. And I think part of it is, and I mean, I've, I've been so privileged to work with such tremendous people, including you, who really are thinking much broader and more conceptually around all of these factors. You know, whether it's addressing food insecurity, whether it's addressing stigma, whether it's addressing you know, violence, whether it's addressing structural barriers. I mean, all of these are at play in different communities. And what we know at least from South Africa is still close to 40% of people living with HIV are not on treatment. And that means not only are they not getting the medication they need, but it also means that obviously there's still a risk for transmission. So it's, it's really in many ways the deepest challenge that still exists there.
Yeah. And we still have, I mean, we have a lot of people in the States also who aren't on medication.
So, so Carly, you have a favorite question that you like to ask that---.
I always, yeah. So if you, you know, in your ideal world, you know, so you're in, you're doing all this research in South Africa, what is your ideal intervention? If everything worked perfectly, what is your magic wand to, you know, fix it or intervene and, and sort of solve that 40%.
Anthony Fauci calls you tomorrow and is like Ingrid you have an unlimited budget. I'm just going to give you a blank check.
And all the resources. Yeah.
I've been waiting for Tony to call me, gosh darnit.
You know, that's special X, NIH grant,
God. I love that idea. You know, look, PEPFAR had a massive budget for a reason. It was about bringing treatment to Sub-Saharan Africa, but it also was about building up a system that had not existed before in many places. And at the time South Africa, it was in under a different president who was really an AIDS denialist. And so they essentially had to build a system from scratch because the president would not allow them to come into the public health system that was in place. So, you know, massive budgets help. I think that, you know, it isn't, I think the key is there isn't a one fits all. I wish I could say there was just one obvious intervention. I think, you know, I would have written that grant a long time ago. That would have been good.
So he did it and everyone would be on there
It would be done and I could move on, and I have other stuff to do anyway. So I remember so well. But you know, it's far from the reality. I mean, I think particularly obviously there are different groups that really need different types of supports. Right now we're working on a project for young people. Young people definitely seem to be falling through the cracks in South Africa. Particularly from the point of diagnosis to starting treatment. That's that, that space, again, that I'm, I'm particularly invested in, they seem to actually do pretty well once they start treatment. But the question is why have they not been able to start treatment? And we're trying to develop kind of a, an intervention where we actually help set up a system outside the standard clinic, which just doesn't work well for young people and allow them to get access to treatment in these things called clubs, basically where you have a couple of young people together with a counselor, who's there to support them.
They have a nurse deliver the treatment to them. They have this really supportive, hopefully generative space of other young people. So they know kind of that they're not alone. And keep it really outside of this really stigmatizing heavy system like that. I'm hoping fingers crossed might work for young people or at least be a piece of the puzzle. But then you look at another group that I've been thinking a lot about as migratory men migrants. You know, there's a huge migratory population coming in and out of South Africa, both within the country and outside the country. Climate change is driving a lot. Violence is driving a lot. Poverty is driving by far the most of it in terms of seeking economic opportunities. But when you're on the move, there's no way to interface with a healthcare system. So they would need kind of a a different package. Right. And we're trying to figure that out right now. Like what is it that migratory men really need? And I think, I think the problem and the challenge is there, isn't one way to kind of drop in and just say, okay, here's the intervention. Here's what everybody needs. Each group that struggles probably me needs a little something different. And that's why we do a lot of qualitative research. We really try to dive into these communities to figure that out
For this for this current intervention grant that you're doing. I remember being in a training meeting when I was at Harvard med school with David, and David Banksberg, was running it. So we were all reviewing like these different grants that folks were running, we're writing, and I'll never forget it. He started the meeting by announcing your grant score to the, to the team and just talking about what an amazing grant it was, how he was so proud of you. It just was, it was like a really, it was really deep moment. Cause I think I had just met you. And I was like, it was like, Ingrid's a big deal. David is a big deal. And, and you know, just to like, he's like, we need to start this meeting with five minutes of really talking about how great Ingrid's approach is. And it really does kind of mirror what you're saying. Like different people need different things. And what he really, I think liked about the grant. If I remember correctly, was he, I forgot what, how he phrased it, but he just was like, she's, she's putting it all out there. Like she's, she's coming forward with like all the intervention tools she's offering up lots of things at different levels. And we're just going to see what works. And so it was, it was a really kind of neat moment to see a mentor, especially like taking so much pride at his mentee when she wasn't there.
Oh my gosh. I was saying where was I why was I not there?
He was just really excited about it. Yeah, it was really.
My gosh. You're making me blush now. Thanks. He's I mean, I think having a great mentor really helps. I mean, people can go the road for sure. But having someone who's got your back and believes in you and I think particularly believes in your ideas, right? I mean, I think that's the hardest part. It's scary to put your ideas out there and have them critiqued. And we do that over and over with our NIH grants and our manuscripts and all these ways that we try to put our ideas out into the public domain. And there, you know, th there are a lot of arrows that come at you. So for every, every one of those to get, you know, somebody who's rooting for you means a lot. And I feel very lucky I've had that.
Yeah. And I mean, one of the things I'm hearing about your story with David Bangsberg is, but a team builder, he was like, it sounds like, you know, and still is, but when one of the things that was important for you is to be part of this group. And I know that was like a multidisciplinary group, like a lot of different people from a lot of different backgrounds at the table, all talking about HIV and global health. And then that's something that I think you really Excel at, you know, bringing together people like you rec you're, you're recognizing the complexity of the problem. And then you're like, you're going out there and you're bringing in all of these different people with different expertise and to think about it with you and kind of like let them loose and let them do their thing with the, you know, either data analyses or project planning. And so to me, it's, you know, it seems like you're, you're really doing a great job with this like team building and interdisciplinary research for these big interdisciplinary problem.
Yeah. You're so sweet now. Thank you. It's one of the things I actually really love to do is to see people who don't necessarily talk to each other normally in the research world. Of course, I mean, I think in the HIV community, we do actually talk to each other a lot. Thank God. And I think, again, it stems back to how the movement started here, you know, because everyone was forced to work together and, and people who sat in one camp who maybe were like, I don't really want to work. They all had to come to the table. In fact, Tony often talks about this in some of his early dialogue with people who worked on the HIV activist work in the eighties and nineties, he would actually just have them over to his house for dinner, or they go out and eat together.
And, you know, when you break bread with people, this, the walls come down and you have to kind of figure out a way forward. And I think that really sets the tone for this community. And I do think, again, there's no reason that people should be balkanized or living in their own little sphere. You know, that I'm only gonna speak with, for me MDs. I mean, that's just absurd. Why would I do that? I mean, I speak, I speak a lot with MDs and we do that a lot, but it's, this work is just way too complex. And, and, you know, I, I so benefit from working with people like you, Val, and socialists, other social scientists and epidemiologists and anthropologists and economists. It's just like, it's such a joy. And it helps me see things, my own blind spots. Right. Which I obviously carry. And it's, it's thrilling to, to get to learn from great scholars like you. So it's a treat for me. I really enjoy that.
You know, and it also just makes me feel like, or think about the problem problems are these problems are so big, you know, and to feel like you're up at bat on your own, trying to figure some of these things out, it just feels really impossible. But when you feel like you've brought your whole squad to the field, or like, you know, you've got all your people there, David Bangsberg, is there, your health economist is there, like they're all there and you're gonna do it together. That's, you know, that's been, I feel like the magic happens, you know, and that's kind of what can be really neat about assembling a team for a grant is to like, who do I need in the mix to take on this like really challenging problem?
Yeah. I was just, in fact, I was just speaking at a conference yesterday about the need for squads. Oh, this was more in the context of like women and leadership, but,uyou need a squad no matter what, right. And this is like your research squad. These are the people who feel equally passionately about these issues and come in with their own distinct lens. I mean, how much more fun can it be that you you're all charging forward on this? Right. It's I think it's fabulous.
Yeah. Well, you know, you're someone, who's actually like a member of many different squads in a way, because at work you wear a lot of different hats. So you have your science hat, which we're all like glad that you went to South Africa and saw, had this observation and decided scientific method is the way to go.
But you also,
You know, you have a physician hat, you now have a teacher hat and you also had the director of the Harvard global health Institute hat. So I was, I was wondering when I looked over, you know, kind of the scope of your career, what's that the, like what's at the center of it for Ingrid Katz. Like what's what ties all of those things together for you?
Well, I should clarify that I'm the associate faculty director. I don't want to overstep my authority. (laughs)
I'm just going to keep calling you the director! We're in a post-truth world, from what I hear
Okay okay in a world of misinformation,
I'm gonna call you--
Well you are now
Okay so associate director.
I feel like that's a great question. I mean, I think these all kind of run together for me. I mean, I don't see them as distinct entities, perhaps I probably should because maybe I'd have a little bit more of a clear path. I think David saw this in me early on. I tend to be someone who stretches my arms out wide and kind of goes for things that I think will be an interesting journey. And this is probably why, again, the path is only clear to me in the retrospect. And so, you know, this opportunity to come, I mean, I've always tried to balance some clinical work with research and that had I mostly wore was resear--. I would say 75% was researched about 25% was clinical. And then this opportunity came along a couple of years ago to come join the Harvard global health Institute and really be connected to global health work that was happening across the university here.
And I just felt like, I really couldn't say no. I mean, it just seemed so exciting, but you know, there were a lot of people who say, well, this isn't quite the right time and your career, you know, you have to stay in the.... David always said, get in the funnel, Ingrid, get in the funnel, get in that narrow part of the funnel. And I always, always at the wide end of the fast and he's like, no, no, no, to advance, you have to be in the narrow end. And he was saying that just to support me, he wanted to see me succeed. And that's how people tend to succeed in academia is you're in the narrowest part of the funnel. Your area of research is extremely narrow, but deep. So you might be like the expert in X, Y, and Z. And that, and you were known as that person.
And I get that right. Because like, when people think of X, this person, they go, Oh yeah. She's like THE expert, stigma, researcher, boom. Like that's who I think of. I think of you for a lot of other stuff too, but I mean, that's, that's like your brand. And he saw, I was like, well, it was a little of this and a little of that. And it was funny at the end of the day when this opportunity came along, I told them about it. And I said, David, you know and he's no longer here he's in, in Portland being the Dean of the school of public health there at OHSU and I said, you know, this opportunity is coming along. And I was kind of assuming, he'd be like, Ingrid, there you go.
Again, you're not staying in the narrow part of the funnel.
And I said, you know, I just think it's kind of cool. What do you think? He's like, it's cool. And it's exactly you.
And, and not only that, he called up the person who was the faculty director at the time who is also subsequently moved on to Brown. And he gave him a shout out to me about me and said, look, I really think Ingrid would be great. And next thing I know, without any further ado, the faculty director called me. He's like David Bangsberg thinks you'll be great. So you should come and do this. Wow. And it was like, okay, that was not expected. And I think it's really a moment where a mentor sees you. Right. And they say, he's, he's watched me over 10 years where I keep backing this trend and I keep going. Yeah. But what about that?
That would be so cool. That'd be so interesting. We should pursue that idea, you know, and I think he just realized this is Ingrid. Like she likes big ideas. She likes to move between worlds. She likes to work with different types of people. She likes to think about ways to solve tricky problems and have lots of good people at the table. This is who she is. Right. And so like, let's just lean into that. And I really appreciated that because that was not necessarily what he had envisioned for me to be successful, but it was what he understood about me after working with me for a decade that would make me happy. And so I pursued it and I have no regrets. I mean, I think it's added a lot more complexity to my life in terms of time management, but it's just been great. It's been fabulous. I've learned all these different, new skill sets. And at my age to learn new skills is really a gift. Like it keeps you from, you know, atrophying and, you know, when you're old, like me really appreciate those opportunities to come around. So I, I have no regrets at all. It's been great.
That's awesome. I just did this. Or I'm doing this professional development program. And I was, and I emailed my brother as part of it. And I was like, Steve, can you tell me some things about myself? And, and, you know, and one of them was like, what are your greatest gifts? Which I, like, I felt so embarrassed to ask someone that like, in a serious way, but it was my brother. So he goes, he said something like, you know, you just, you really like to try new things. And because, you know, one of the things I've tried late you know, during pandemic is skateboarding. So he just brought that up. He's like two years ago, you're running, don't worry Ingrid, doing it with like all of the pads. It's like boarding, it's a longboard and helmet, for sure. So, and then he made some joke about how I, you know, my other greatest gift is like really sticking to teenage drama.
But I think that what's neat about, you know, David Bangsberg, this part of the story also is just that so many times I think mentors want their mentees to do like exactly what they've done. And so for him to say like, no, you go do your thing. Like you do this other path is really, is really impressive. I mean, I think that I don't, I don't know why more mentors don't do that, but, or maybe, maybe sometimes as mentees, we feel like our mentors will be disappointed if we don't take the past. Maybe it's kind of like both both ends, but for a mentor to be like, yeah, you go do this totally different thing. And that's going to be a great thing for you is also pretty neat.
Yeah, I agree. I mean, I think it's complicated for many mentors because, you know, there is this incentive within academia. Like if you have someone really close to you, it also helps improve your career too, because you're kind of in the same sweet spot together and they are productive and you're productive and everyone wins. And, you know, I just think David gosh, he's worked with so many different types of people. And I think in a way, when you have that ability to work with lots of different people who, who bring different things to the table, and I can see now, when I sit at the other side as a mentor, the joy, it brings me to see people find their passion and that my career doesn't rest on any of their backs. I think it's very freeing, you know, that they're, they're able to pursue what they want. I can help them in whatever ways I can. And sometimes I can't help them because their, their path is so different from mine, but I can at least help guide them to the next step so that they can continue on their journey. It just, it's a deeply meaningful and joyful experience.
Well, speaking of what seems to be joyful experiences and also Ingrid taking on like new things every couple of years and learning new things. So now I'm not sure if it's as part of your role at the Harvard global health Institute, or if you took this on as a separate thing, but you're teaching this class on COVID. And I think it's like, what is it? COVID I had it written down somewhere, but like COVID plus history plus politics maybe or something. And it seems to be...
This really remarkable experience. So we'd love to hear a little bit about, I know it looks like you started conceptualizing the class over the summer, but how has taking on this, this new thing been going? So now we've got like physician and researcher,uteacher it's like all, all of the things, all-star, all the things. Yeah.
This has been so fun. So this is a, it's called confronting COVID science history and policy, and it's a course that's being offered through the gen ed curriculum here at Harvard to the Harvard undergrads. And you know, obviously we did not have a long time to prepare for a course like this because we didn't really conceptualize how massive COVID would be until probably kind of the end of the winter early spring. And I'm just so darn lucky. This is actually in complete partnership with someone named Allan Brandt. Who's a professor at Harvard. Who's illuminary. I mean, he's, I could go on about Allan for the rest of this time, but let's just say that he is a brilliant scholar. He's in the department of history of medicine. And he's been the chair of our steering committee at the Institute.
And I got to know him since I joined the Institute. And we had been in conversation over time about what's happening with COVID certainly in the winter. And he reached out to me maybe end of March early April and said, taught at the university side for years. He said, I think we should do a course. And you know, he doesn't need a course like this. Like he is like senior tenured. He's good. Like he could just do his research and do his jam. And, but he saw such a need in this moment, particularly for the undergraduates. And we didn't know at that point, what was going to happen. We knew that the undergrads were being asked to leave the campus and the spring, we didn't know what the fall was going to look like. And I said, well, look, I've taught medical students. I've taught residents.
Some fellows I've never taught undergrads. Like, I don't even know what the heck this looks like. And you know, it was really his vision that brought it all forward. And you know, here we are, it got approved through the gen ed curriculum, which has to go through a process. We were super lucky to get that approved. We have 130 students in our course right now we have a team of teaching fellows who are phenomenal and excitingly. We have over 75 faculty across the university who have come into our course to lecture. It is amazing. I'm just, I'm not even like, it sounds absurd that I'm going to talk up our own course, but I love it. This is part of the dialogue I want to be in. Right. Cause I'm so immersed in COVID as we all are. And what's been so fun is to do this with a historian.
So, you know, I'm coming in with my biomedical. Oh yeah. I know. But these people over at the hospital, I know these people over the med school at these people's school of public health, he's like, well, how about these folks in the arts and the humanities? How about these folks? In, you know the English department, how, and he, to be fair, he also has an appointment, the med school. So he knows, he kind of just knows everybody across the so it's just been such a joy and, and every session is eye opening and shocking and like all the good ways and all the pieces that I feel like I thought I knew this, like we had this amazing session on prisons and incarceration, and I had no idea there is not a national standard for healthcare provision in prisons.
And so, you know, cause we have to be held at the hospitals to national, like people come in and they evaluate how we're doing what we need to improve.
There's nothing like that in prisons. And so you can imagine a situation where people, you know, mass incarceration, a pandemic an air airborne, pandemic breaks loose, and there's just no system in place to protect people. And it's a nightmare basically. And I was learning so much in that session and I will encourage your listeners after much work. We have it up online, it's available on YouTube. You can go to our website at the Harvard global health Institute and link into it. And it's available to anyone. So you can drop in. If you see a session, we just did one on mental health this week. That was really interesting and engaging. We've had amazing speakers: Paul Farmer, Atul Gawande... I know it's so great. So great.
Now can you just imagine, this is the type of class that if you're an undergrad, it's a once in a lifetime class and for like, you're going to be talking about that your entire life, like the people that you have circling through this. I mean, I'll see you on Twitter. Like, you know, you'll post pictures of the people at the table and I'm just like, What, like, right. From CNN to your classroom for the undergrads, it's insane. Like the quality of educations.
Well, we're super lucky. I mean, obviously Harvard's a massive university and so you can pull upon all these great faculty and what's so amazing to me is all these people in all these different disciplines, none of them were working on COVID a year ago because it wasn't a thing a year ago. Right. And yet suddenly here you have all these tremendous faculty who are leaders in their fields who have either incorporated COVID into their portfolio or have made it their true focus right now. And what a phenomenal thing to get to hear about that in the context of all these other discussions. So once again, I have veered into this like massive kind of big picture thing that is really, I find it super fascinating, but you're right. It's like a huge time commitment and doesn't totally, I don't know if it makes sense with my career or not, but it's a whole heck of a lot of fun. So I'm just kind of along for the ride right now.
I mean sometimes, so you just need to do the things that fill our tank,
And this seems to really, you know, fill the tank.
We're to have to check in with you in a few years to see if you can connect the arc for us.
Then rode my bicycle to the zoo.
I told you the bicycle story. Yeah. You know, I do, I do feel very lucky. I think part of it is I have, my brain is wired in a funky way. I have some dyslexia. I'm always been a big picture. Yeah. That's just how it's always worked for me, which why you know, the first two years of medical school were a grind beyond belief because it's not like that. But I think I've always been a big picture thinker. It's how I can like make sense of things in my world. So I've been super fortunate that I get to have a job where I'm kind of allowed to do that as long as I can pay the bills, which is always, you know, that at the end of the day, that is always the question. Can I pay the bills with what all these different, funny little pieces that have come together, but so far so good.
Well, let's land it then. Cause the last thing we wanted to actually ask you about is it's the person who helps you pay your bills (laughs). Oh, you are one half of a very dynamic, super power. Couple. We're going to say, so your wife Alexi Wright. Is also a physician scientist. And we were, we were wondering a little bit about just what's the, what's the life like for these two bad-ass physician scientists and in the context of that we had read the paper or the commentary that the two of you wrote in new England journal of medicine, which, you know, not a terrible journal about burnout experienced by physicians. And you know, so we were just, we were wondering what's life. Like for the two of you, is burnout a concern or sort of that the high stress of wearing all of these hats, what does it, what does it look like?
Well, I have to say like insanely lucky to have married my best friend and you know, I can't imagine my life without Alexi and she's, she's totally the rock star in so many ways. And I just am so happy and you know, lucky to walk this life beside her and, and it's a hustle, right? It's a hustle for all of us. I feel like I was telling her today. I was like, I think I have induced ADB. Like I don't have ADHD, but I'm like, where am I? Where am I supposed to be right now? Where am I going? Like, what should I do? Cause I just feel like it's, it's a little chaotic, but I don't think that has anything to do. It's just me in my life. It's not related to her, but she's kind of equally as stretched. And then we have a 13 year old, who's doing his 13 year old thing. And then we just got a pandemic puppy. Lord only knows why, but that's what we did.
We are the, our whole lab is the biggest fan of your pandemic puppy. They did a deep dive on your social media and you know, Pickles might become like our, our lab mascot, all of the RAs are available for Puppy sitting
Come, anytime he is a sweetheart. But you know, it's like another life.
Yeah it's a lot of work.
But I think, you know, for Alexi and I met in, she was his first year med student. I was doing a postdoc program. So we met, you know, early in that journey. Although we both went to med school late, quote unquote later in life, I was 28. She was 26. And you know, I think we were old enough to kind of have a little sense of ourselves, but obviously young enough to have a big piece of our journey in front of us. And so this was back in the late nineties now, early two thousands. And when we graduated from med school, I was at UCLA, she was a Penn. We decided to couples match, which at the time it's like was so controversial. Cause we were going to come as a couple, identified as such, not as buddies or as sisters, as we have often been mistakenly called.
I'm like, no, wait, why do you think like we don't even look alike, but it's like, I think people couldn't get their mind around it. And it was still, you know, there was still, obviously there's still a lot of homophobia in this country and you know, we did the tour around and UCF was super supportive of us as a couple. I can't say that that was the advice that we got everywhere. I think some places were like, don't be out. And I was like, heck no, like we're together. We actually ended up getting, having a commitment ceremony in 2003 before it was legal. And then we got another wedding when I was pregnant with Tomas just to like, I don't know, cause we were like old fashion and like we needed that. It was so weird. I was like, I never would do this if we were straight, but somehow I feel like we should.
So very strange.
So we got all of the parties, you and Alexia should get all of the parties.
We had a lot of fun was great. And you know, we, it was, it was monumental for us. I mean it was political. We got married on the top of Mount Tam, which overlooks like the whole Bay area. And it's just like, Oh, that's so beautiful. I think I basically cried. Like every picture is a disaster. Cause I'm crying the whole time. I was like, shouldn't someone have told me to smile. Like I must. So I was such a mess, but yeah, now, well it was, it was a beautiful setting.
I'm sure it was beautiful
We had a great group of people there with us. And then, you know, because we were very much aligned and allied, we came in as a couple. We were the first openly gay couple to match at any of the Harvard affiliated hospitals.
And the mid 2000...
In the mid 2000s?
Okay. 2003. And the Brigham was like opened up, you know, welcomed us with open arms and they were like, we love you guys. And so they kept us in sync. You know, when you match as a couple, you can sync up your schedules, which cause you work like a hundred hours a week and we didn't have a kid at that point. So we we were always together and like our whole lives, like we wrote a blog together and we ended up doing this gig with the new England journal where we were you know, writing for them pretty regularly for awhile in, during our residency. And so it, you know, it's just kind of, I can't really, I never would want to imagine my life without her. She is really my better half and you know, we hustled like everybody else, who's juggling a lot and trying to figure it out.
And I mean, the proof will be in the pudding. If our kid is still like, you know, copusmentus by the end of this, you know, when he goes off to college, then you know, we'll now. But I think, you know, it's cliched, but you know, finding the life partner who will lift you up and support you is, is just so critical. And I feel so lucky that I get somebody who gets to do that with me. And you know, we're super, we're super lucky. We live in Cambridge. It's like, you know, we live in a very supportive and open community and we've never had to do be anything other than exactly who we are. I think because we live our honest truth. People assume that like they just expect it. Like there's nothing else to be said, you know? And I think that's been a gift that we've, we've enjoyed this ride the way the country has in the sense that, you know, right.
As we were coming here, Massachusetts made marriage legal for gay couples and then the country kind of followed along. And I feel like this was the wave. I mean, we weren't at the perhaps leading edge of it, but we were right there. And I feel so grateful for that. Cause I know a lot of couples who were older than us struggled with this, you know, in the sense that there just wasn't this affirmation and there still are lots of places in this country where there isn't that affirmation, but I'm so I'm, so I'm heartened to see young people now and how much more open our society is around. So much more than sexuality. About gender identity, about all these pieces of our lives that, you know, I think we're much more complex in terms of how society kind of embraced everybody back in the dark old days, which really wasn't that long ago, but the younger generation moves us forward. Right. That's what it's about. It's about pushing the envelope and that's what matters.
Well, you know, if you're, if you're at the beginning of the wave, you're you and Alexi are there to break the shore and then you have the people in the back to, to keep the momentum going and push it further up. So yeah, it takes everybody working together to, to really make it work, which is amazing
Because that's what a social movement is about. And I think that's part of what's lifted us forward. I mean, I think we would, I would be grateful to be in this couple no matter what, but I think in some ways to be riding through this time together, very openly, very supportively. I mean, who works with her, knows me, everyone who works with me knows her, you know, it's, it's kind of where this identity together and that's what makes us so much stronger. And you know, we have each other's back fundamentally at the end of the day, if I need to travel to South Africa, she's got it. If she needs to go lead a conference, I've got it. Like we have each other's back in small ways like that. And then obviously in much bigger ways. So we're, we're, I can't say enough about how lucky am I feel so cliched. I feel like I'm on a hallmark card.
It's wonderful. It's fantastic. Yeah.
So it's a hustle for everyone, it's a hustle in all ways. But that's it for everybody, right? It's, it's always tricky to try to being an engaged parent. That's really important to both of us and trying to find some space for a little bit of self care, which is, you know, in big demand right now and, and community. I think, you know, this time has taught us the need for community more than anything and how tricky that can be and how necessary it is.
Well, it's a Friday afternoon, so we're going to let you go off and get some community and self care and some quality time with Alexi. But in the, in our show notes, we'll post links to your course, which is on YouTube and everyone can go see it. We'll also link to your social media, Twitter, and Instagram. So people can see pictures of pickles and also they can tune in for all of the amazing, we didn't even get to this like advocacy and public engagement that you've been doing around COVID our personal lab favorite is when you talk to the kids at time unanswered questions: Can COVID live on my volleyball? All the way to what was my favorite? Oh, like, can you, can you weigh the pros and cons of all of this antibiotic or all of this like hand sanitizer use, given what I know and have heard about like antibiotic resistance, my God it's like these kids are amazing.
They're amazing what a joy.
Yeah. You've been doing such a phenomenal job, just like getting out there and educating people about COVID and we've had discussions about how important that is. So we're just so grateful that you're out there doing it, even though you really don't have time for it. So we'll post all of that, but Ingrid, thank you so, so much for your time today, you're one of my favorite ever sex and drug scientists. So we're really grateful for you.
Mine too now
Aw thank you
You're really the nicest of the sex and drug scientists and I'm so grateful to, I consider myself a member of your squad. So thank you for creating these groups and thank you for inviting so many people to them.
Yeah. Well thanks about it's, like I said, it's an honor to be here and it's people like you and Carly who are leading the way and I'm just so thrilled to be part of this. Thanks for including me.
So Carly, the undergraduate research assistants who help us with producing this podcast brought up a really important thing that we talked about in the episode, but probably didn't make sense to anybody listening.
I know the grant scores. I also didn't know until we were talking about an unrelated grant when you explained them to me. So for our listeners....
So what happens is you know, you researchers write grant applications, which are essentially a pitch to the National Institutes of Health or a different type of funder. And they say here's a research project that I want to do. And then that goes to a group of reviewers who are other scientists who read your grant and then give you a score. At the National Institutes of Health, that score ranges from 10 to 90. It gets like even more confusing because 10 is the best and 90 is the worst. (laughs)
It's like golf, try and get a lower score. Okay.
Okay. So essentially in this grant application that Ingrid or that we were talking about with Ingrid, she got a really good score. So she essentially got a low score and low scores like between 10 and 30 are actually really hard to get. So yeah, I just, I always remember her mentor, David Bangsberg being just like so glowy about this really terrific grant score.
Well yeah. That's super hard to do. And pretty amazing.
Yeah. So if you go out into like academic Twitter, you see like around grant review times, like people like posting their scores and I mean, it's nice. Yeah. But it's terrible. Like rife for terrible social comparisons.
Well I'm sure it's really hard to get that low of a grant score, but I honestly think it must be harder to bike 70 miles a day. Are you kidding me? Like I would be exhausted after like a smooth seven.
Yeah. So the other thing that the undergrads flagged for us was what's this Bike Aid thing that Dr. Ingrid Katz did. So Bike Aid was, we did a little bit more research on this and it was started in 1986 and it was a way of raising both funds and awareness. So it seems like the bikers raised money. So they would be say like, you know, give me a dollar for every mile that I'm going to ride. Then they would like leave from the West coast. And they would bike to the East coast. It was a lot of biking,
So much biking. Yeah.
And then along the way they would do like service and volunteer projects. So we saw somewhere where it was described as like the peace Corps on wheels. So Ingrid left in 1993. So she did the ride in 93 when she graduated from Amherst and she, we think that she raised money for HIV. And then she also did direct outreach, like along the way, which is pretty neat.
That is just amazing. Like, and also what a cool, like she said, that was one of her like aha moments or however she put it, you know, like, I bet it is. Yeah. You have a lot of time thinking on the road, like doing all those different things with all those communities along the way. Like that has to be the coolest experience.
Also like all those exercise endorphins like anything you're doing right. Then you're like my colleague, like, she's like, can you imagine like, like Ingrid Katz, super smart woman, like biking over a mountain, like focusing on doing good for like the world and specifically like HIV. And she's got all these exercise endorphins, and she's like, this is it. This is what I'm going to do with life.
And she probably honestly like mid-bike ride was probably like, and that seems very easy compared to what I'm doing right now. So it's probably also that energy too. Yeah.
She's like anything in comparison to, to this mountain,
Right? Ingrid Katz is such a, such a wonder woman.
Such a wonder woman! No, she really is. I mean, that ties together, like all of the different things that she's doing. And I mean, we talked about this a little bit on the podcast, but one of the things that I really admire about Ingrid, especially during the pandemic is how much outreach she's doing and how much she's speaking up, like early in the pandemic, Ingrid and I wrote a commentary that was published all about how, cause I was like really stressed about misinformation... It was like back in back in March and April, you know, I'm a stigma researcher and people were like, "Oh, stigma is going to be a big deal." And I was like, sure, but conspiracies people, I was like, misinformation is going to be a big problem. Ingrid and I had studied this in the past, in the context of a Ebola, so we wrote this little piece on it and we talked in the piece about how important it is doctors to be really vocal about COVID in part, because we have research showing that people trust their doctors and they trust health information from their doctors. So in the next couple of months, like Ingrid put her money where her mouth is and she is super outspoken and she is just out there, like being a face of this and talking to everybody from like kids about right their volleyballs and COVID to, you know, being on the major news networks. And I think the thing that people don't appreciate is like, this is not Ingrid's day job. Like she has like three other day jobs doing, she has a ton of stuff to do, which is why when we were working on that commentary, she was like responding to me at midnight, you know?
Super busy. And she's still really prioritizing getting this information out. And I think that's really amazing,
Which makes us even more grateful that she took the time to speak with us today.
So grateful. Thank you, Ingrid!
Thanks to the Stigma and Health Inequities Lab at the University of Delaware for their help with the podcast, including Saray Lopez and Mollie Marine. Also, thanks to Kristina Holsapple for her editing skills,
Thanks to city girl for the music, and as always be sure to check us out on Instagram @Sexdrugsscience, and be sure to stay up to date with new episodes by clicking subscribe
And thanks to all of you for listening.