Tips for Junior Medical Researchers: An Interview with Dr. Peter Small

The traditional health care path is a career in clinical practice and patient care. However, there are numerous other paths that people might take. Some will pursue academic or industry careers in medical science and research. Others will become public intellectuals writing blogs and books. Some will move between fields focusing on innovative approaches to achieve global impact.

This week I had the honor of conducting a phone interview with Dr. Peter Small, a global health leader with experience in clinical infectious illnesses, academic research, product development, and innovative health delivery systems. In this interview, he offers some tips for junior medical researchers that will help as they navigate their chosen career path.

Marion Sereti (MS): Thank you for accepting this interview. How would you describe yourself and with the events that led to your career today?

Dr. Peter Small: I have had an eclectic career, which some people would call chaotic. I started as a doctor at UCSF in the dawn of the AIDS epidemic, then moved down the road to Stanford University where I was a clinical investigator. In 2002, I moved to Seattle to build and run the tuberculosis program for the Bill and Melinda Gates Foundation. About a dozen years later, I returned to academia and built a global health program at Stony Brook University.

The common theme in my career has been bringing innovation to improve healthcare. And the persistent thread through all of that has been cough, which is a prominent symptom in general and a primary manifestation of tuberculosis (the focus of my professional career for over 30 years). In addition, I also have had a chronic cough 40 to 80 times a day for the last 30 years. My current job is Chief Medical Officer at Hyfe, an acoustic A.I. company focused on cough. In retrospect, I could pretend this was a coherent plan, but it was actually just driven by taking advantage of opportunities as they presented themselves.

MS: Hyfe, a fast-growing startup, is a mix of science and computing. So how did all of this lead to you taking the position of Chief Medical Officer at Hyfe? What do you believe is the most important part of your role in the artificial intelligence/machine learning field?

Dr. Peter: I will not dispute the role of luck, but in the words of Louis Pasteur, “Chance favors the prepared mind.” For me, part of being prepared has meant having a willingness to work across disciplines, which in turn has led me to the world of computing. Over the decades, it’s come to play a prominent role in so many aspects of my work and life.

However, on closer inspection, it’s for many reasons — the timeliness of cough in the Covid era; the value of empowering patients with the data they need to drive their own health care; the rate at which mobile phone-based technology can scale. I want to be central in ensuring a future in which every smartphone in low- and middle-income countries will be a lifesaving medical device.

As an employee of a startup, I am coming to understand that startups are often misunderstood by scientists. I once thought that a startup was four kids and a foosball table in a garage in Palo Alto, who aspired to be Elon Musk. But in reality, startups are a very structured approach to creating products and services in unstable environments. And, as such, they are exciting places for young scientists to pursue innovative dreams. As the chief medical officer at a start-up, my job is to ensure the focus of our work ultimately benefits patients and providers.

MS: Acoustic epidemiology is a relatively new term to some. What does it encompass and what are the discoveries that have led it to be your current work?

Dr. Peter: Acoustic epidemiology is the use of sound to better understand the dynamics of diseases. I have always worked at the interface of many different fields. And the intersection of epidemiology, acoustic artificial intelligence, and machine learning is a very exciting space, which I think will teach us many things about the cause, distribution, and management of disease in individuals and populations.

MS: After decades of experience in this line of work, what do you think are the most notable differences over time in the medical/cough research given your experience in this field?

Dr. Peter: In college, solving engineering problems involved submitting stacks of punch cards to the desk at the computer center and subsequently checking my bin for the output. Years later, I was analyzing the DNA fingerprints of thousands of strains of bacteria, all thanks to a computerized image analysis! And now I’m working in the ubiquitous field of A.I./M.L. to advance various aspects of the practice of medicine.

Artificial intelligence is the most transformational technology at play in healthcare today. It’s an extremely data-hungry technology and so its applications were initially focused on the most data-rich aspects of healthcare, which were images. Thus, the early applications have been in radiology and dermatology. Now, people are using AI for task management and medical decision-making using electronic medical records, but these are actually very small datasets. I’m super excited about the next richest dataset, which is sound, and think that the interpretation of acoustic signals using A.I. is going to be extremely productive in the coming years.

Hyfe is currently focused on cough, which is a very high-value target, but there will be other sounds like sneezing, laughing, and snoring, which will subsequently benefit from this type of approach.

MS: So, what have you learned, since you embarked on research, that might be useful for educating prospective scientists who want to have meaningful and significant careers? What is your advice for young researchers?

Dr. Peter: My advice for young researchers is this:

Focus on timely and significant issues. I graduated from medical school and moved to San Francisco just as a new disease was emerging among gay men that also intersected with TB, a disease of antiquity. My mentors at the time pointed out just how big of a public health threat this was going to be and, together, we made confronting this convergence the focus of our work.

Exploit every opportunity to pursue excellence. I have been fortunate to work at amazing institutions, but such places don’t have a monopoly on incredible people. The key is to engage with great mentors and colleagues. My mentors have been a major driver of what I have accomplished and many of them remain great sources of inspiration to this day.

Find new technologies that are fundamentally changing scientific paradigms. We live in a world where technologies are changing at an exponential pace and opening novel opportunities for scientific advancement. In my career, I’ve moved from genetic fingerprinting to population ecology to biotechnology and am now loving the potential of machine learning.

Seek to match the magnitude of the problem to the magnitude of the response. Rather than pursue a predictable academic life, I ignored my Dean’s advice and became the ninth technical hire at the Bill and Melinda Gates Foundation, where I had the opportunity to shift from “What can we do?” to “What should we do?” For 10 years, my team spent what it took to develop improved approaches to TB care and control. The sweet spot is in the intersection of important problems and big solutions.

MS: Junior and senior researchers alike are often under intense pressure to publish, and they are burdened by an increasing bureaucratic load with minimal administrative support. What does this mean to them and what suggestion can you offer?

Dr. Peter: The transition from being a student to an independent investigator is undeniably a complicated one. As you suggest, there are many competing challenges and demands on one’s time. I think having a supportive environment (both your peers and institution) can make a huge difference. But at the end of the day, I really feel that it is the passion and grit of the individual that gets people through these difficult times.

MS: In the field of cough research, what advice can you give young scientists on the best research strategies and resources?

Dr. Peter: Cough science is an exploding field. Coughing is one of the most common reasons that people seek health care, and yet to date it has not been objectively measured. The emerging ability to unobtrusively monitor cough and record its pattern and sound is opening up a ton of important questions, starting with descriptive epidemiologic projects about the pattern, frequency, and sound of cough during different diseases, which are leading to subsequent hypotheses about what those patterns might mean. I would say that for a young investigator the acoustic epidemiology of cough provides an incredible opportunity for research projects with legs.

MS: What networking strategies can junior medical researchers use to their advantage?

Dr. Peter: Well, the pandemic and shift to increased remote work is a double-edged sword. It has decreased the opportunities to be in dynamic physical environments like research institutes and international meetings. On the other hand, it has created opportunities for remote collaborations that were previously unthinkable. The key is to put yourself out there…unsolicited emails, Twitter posts, and crawling digital networks can help make connections.

MS: What’s your best piece of advice for young researchers on research ‘failure’?

Dr. Peter: My experience is that failure is far more common than success and, in fact, I would argue that most of what I have learnt in life, I have learnt from mistakes. It’s an intrinsic characteristic of science that most experiments will fail and the critical attribute of a scientist is the ability to learn from their failure and the resilience to try again with a refined approach.

MS: Thank you for your time. As we wrap up this interview, what does success in cough research look like to you at the end of the day?

Dr. Peter: The North Star for everything that I do is improving the quality of care provided by health systems and the quality of life of patients. Hyfe aspires to do for cough what the thermometer did for fever.

Take Away

Above all, it seems the most important ingredients for a successful career as a medical researcher are finding a mentor and a topic that interests you, delving deep to address key challenges, and having a genuine enthusiasm for science.

Cough science is one of the untapped research niches. Hyfe works with researchers all over the world to pioneer the field of acoustic epidemiology. The most common applications Hyfe is exploring in research include:

• Empowering coughers to understand their cough and change their lifestyles in ways that reduce it
• Enabling health care providers to better understand the pattern of patients' cough so they can manage it better
• Rigorously monitoring cough in individuals for fundamental research about the determinants and management of cough
• Aggregating cough data in populations to improve pandemic control and general public health
• Using cough as a biomarker to improve the efficiency of drug development

These methods of data collection appear to have no end to the studies they can be used for. For examples of what can be learned from these research techniques, visit Hyfe’s Publications page.