Science for Social Good: Tamar Krishnamurti

Tamar: If you're trying to do social good, you need to create something that's scalable, that you can disseminate in a wide-scale manner so that it reaches as many people as possible.

Mike: From CTSI, this is the Products of Pittsburgh. A show about the people in Pittsburgh – innovators, scientists, community leaders – and the remarkable stories behind how they came to be and the work they’ve produced. I’m Mike Flock.  On the show today, we catch up with Dr. Tamar Krishnamurti, Assistant Professor of Medicine and Clinical and Translational Science at the University of Pittsburgh and Co-Founder of Naima Health.  

Mike: Tamar is a behavioral scientist and decision-making expert applying her unique skill set and experience to better engage patients in their clinical care, and help people make informed decisions regarding their health and wellness. Tamar was born in England and, in fact, her parents named her after the river that flows through the southwest portion of the country.  They moved to Scotland when she was a toddler and, at age 10, the family moved to Pittsburgh where she has been ever since, although not without a few adventures in between. Tamar had set out to study both classical music and biology. An interesting combination. However, a life changing experience would set her on a journey around the world and eventually back to Pittsburgh.

Mike: Did you have any particular interests or ideas of what you wanted to be when you were going to grow up?

Tamar: I think I always wanted to be a physician, actually. I had this this vision of myself being an OBGYN from a very young age and then I also got very into classical piano and spent a lot of my childhood doing that so I was torn about whether I wanted to go into music or if I wanted to go into science and that kind of tension actually stayed with me up until college and then I was kind of applying to music conservatories and also thinking about science and then ultimately I went to CMU and was able to do both, trying to kind of balance a heavy music curriculum and heavy bio curriculum and then I actually had a couple of things that happened. A friend of mine from high school was killed in a car accident and I felt this tension of whether I want, you know, this tension of pursuing music, pursuing science, not really being a hundred percent sure of where I wanted to go, and so I decided to take a year off, and I did a few things during that year. The first thing I did was I went hitchhiking through the southern part of Africa with a friend of mine. Quite an adventure, yeah, so that was purely finding myself element of that year I think, and then we hitchhiked out to a school and we worked in a school for a little bit with a friend who was doing her own gap year there and mostly just, mostly just had adventures really and then for part of that year, I wasn't quite ready to come back after my Africa trip so I went to India and I worked in a hospital and in a rural clinic, as well, and then still wasn't quite ready to come back and I also had run out of money. So, I went to London and I worked as a bartender until I saved up enough money to fly back to Pittsburgh and start college again.

Mike: Wow that was quite the adventure or least a string of adventures.

Tamar: It was, yeah. So, I came back to Pittsburgh and did my sophomore year of college but working in London had been pretty exciting so, I applied to do a year at the London School of Economics (LSE) and went there for my third year of college and then came back to CMU to finish up.

Mike: That pivot from biology/anthropology to more psychology and behavioral based research - what encouraged you to go in that direction?

Tamar: I think I was heading in that direction anyway. There was actually no biological anthropology degree at CMU so I had been doing a pretty heavy pure sciences curriculum at CMU in those first two years and I was very interested in the kind of human, more behavioral side of science but I didn't want to do a pure anthropology degree or a pure psychology degree. I really loved the biology and I loved being in my chemistry labs and I wanted to try and look at more of the biological underpinnings of behavior and because CMU didn't offer something like that I had to petition the university to create that major and I modeled the major off other universities that actually had a program in biological anthropology. And so in addition to me you know loving my time in London, LSE had a lot of the courses that I needed to take to kind of compliment what CMU was able to offer so I tried to strategically take the courses at different institutions, including at the University of Pittsburgh, to really make that major happen.

Tamar: When I came back to Pittsburgh, I was actually working for a year between college and grad school trying to, again, trying to do some soul-searching and think about what I was interested in pursuing and I worked for a researcher called Sheldon Cohen. He's amazing, he does incredible health psychology work and we were looking to see how people's social networks and social support were actually affected, their immune response to getting the cold virus, the common cold virus, and how well they recovered and how productive their physiology was in response to being infected. So, we’d given them a cold and they would stay holed up in a hotel and we would do things like measure their Kleenex, wait to see how much they were blowing my nose but also look at things like amount of social support and the types of connections they have in their lives and that had a big influence on me as well thinking about social connectedness and social support of these experiences and I've been kind of thinking about that and reading about that in my spare time and thinking about how the element that was really missing for me in understanding and thinking about these things was decision-making, how those things tied into an active choice that people would make and I happened upon somebody who works at CMU, Baruch Fischhoff, who, kind of, an incredible decision scientist and I just popped into his office one day and started chatting with him and he was so welcoming and we spent you know an hour and a half just discussing decision-making and by the end of that meeting he'd convinced me to not go into medicine or public health which you know is what I was leaning towards but apply to the social decision sciences program at CMU in so that's what I did and I later found out that he lived on my parents’ street and we were neighbors so Pittsburgh is a very small place.

Mike: In 2010, Tamar received her PhD in Social and Decision Sciences and would go on to spend the next several years continuing her training and research career at Carnegie Mellon University. And during this time, also expanding her network. In 2017, Tamar accepted a position as an Assistant Professor in the division of General Internal Medicine at the University of Pittsburgh and today her research in medicine, machine learning, and the decision sciences is being applied to address a variety of public health issues.

Tamar: I want to say that I have some great overarching vision because I feel like that's a very appealing way to be and when we think of great, successful researchers, you imagine that they started out from day one with a grand vision and accomplished it.  I think, in reality, I am driven by curiosity and I think, as human beings we are driven by curiosity about things that end up relating back to who we are in the stage of life that we're in, and so, I think a little of my trajectory has been kind of research me-search. I started out thinking about adolescent contraception and so I was doing a lot of work on risk perception and adolescent decision-making with respect to emergency contraception as a, kind of, in my early twenties I felt like adolescence was the most recent time frame that I felt like I had good experience with. That was a great kind of big research project for me to start with because I dove right into doing community-based research and I spent a lot of time talking to adolescents who were having to make really big challenging decisions and I think that really helped me to think about the impact that science has on any individual's actual daily life. So I was speaking with 12 and 13 year olds who were pregnant and who didn't have access to other alternatives and how that was really affecting them and changing their lives and I felt very humbled to be given the opportunity to do that and also I think it really drove me to try and stay out of an ivory tower when I was thinking about the work that I was doing and that kind of set the tone for me moving forward. I've done a lot of work in different areas, I've done work in  kind of technology and energy and sustainability but also work on sexual behavior and then I really just started doing a lot of work on reproductive behavior and pregnancy, probably shortly after I had my first baby so, again I think it's just these were things that were on my mind, things I have recent experience with or they prompt, my own life experiences have prompted questions for me that I felt were unanswered or I felt that I could contribute to so..

Mike: So, you have the first-hand experience of potentially a problem or a clinical need and then going out to develop the solution or tool to address that.

Tamar: Right!

Mike: So tell us more about the research around pregnancy because I know you were involved in a spin-out company and you've had a lot of recent success.

Tamar: I think this work started when I was a postdoc. I was actually doing work in kind of environment and climate change but my heart was also very much still in problems of health, and climate change and health are not unrelated to one another. Thinking about all of these things and the environment and how it's affecting fetal development and reading about those things in my spare time and then Baruch Fischhoff, who, you know, I mentioned going to his office and we chatted and he had mentored me through my Graduate Studies, he had met Yoel Sadosky who's the head of a Magee-Womens Research Institute who was working closely with a maternal fetal medicine specialist called Hyagriv Simhan who's at UPMC and we all just started having get togethers, they were these kind of informal, maybe once a month chats where we would sit and talk about behavioral science and reproductive medicine and kind of thinking through our different specialties and we talked a lot about prematurity and prematurity in Pittsburgh where there are some disproportionately high numbers and where there are stark inequities in preterm birth rates between black and white women and during those meetings started kind of thinking about how we could put our different skill-sets together and start to both do a little bit of work on identifying the precursor risks to prematurity and also doing something that was actionable with that information so how could we both think about those risks and then communicate those risks to women in a way that was actually useful, that they could do something with them, and so from those conversations, another colleague of mine who I've worked with for a long time, Alex Davis, he was doing a lot of a work in applied statistics and so it just kind of naturally from those conversations Hyagriv and Alex and I'll started working together on both modeling preterm birth risks and then taking what we learned to try and build something, a tool where we could track those risks more routinely then you could at regular prenatal care appointments and then risks that were actionable, communicate something back to women and so from that kind of initial work and brainstorming the MyHealthyPregnancy mobile health platform was born and is currently being beta tested with 3,000 women at UPMC.

Mike: Tamar and her colleagues won an award from the Pittsburgh Health Data Alliance in 2017 to develop the MyHealthyPregnancy mobile health platform and founded Naima Health, a spinoff company from Carnegie Mellon University and the University of Pittsburgh, to develop and commercialize the technology. Designed by doctors, scientists, and mothers, MyHealthyPregnancy guides women through their pregnancy, offering personalized feedback approved by the healthcare provider and connecting them to local resources and support when a specific risk is identified. But what happens after the baby is born? Well, in 2019, Tamar participated in the Pitt Innovation Challenge, otherwise known as PInCh, and won an award for her project, 42Days, a mobile health platform for the critical postpartum period.     

Tamar:  The support of the MyHealthyPregnancy app ended and then they’ve given birth and they were going home with a newborn and a lot of the support that they've been getting ended, so, you know, going from kind of routine prenatal care visits and spending time with healthcare providers and then suddenly going home and being fairly isolated and having this very new experience and these symptoms and this uncertainty and also very little time to think about their own physical and emotional experience while trying to keep this infant alive and thriving and so it really highlighted a need to me of creating something during that time period. And so from that, you know, we thought about building the 42Days app which is what is currently named and what we proposed for the PInCh award so trying to build something that women could use during those kind of first critical 6 weeks postpartum before they are coming back in to see their health care provider and it is a time when they are at increased risk of  postpartum complications and have been discharged from the hospital system.

Tamar:  It’s tricky when you are trying to do work that’s at this intersection I think of like commercial impact and social good because you have very different audiences that you need to appeal to and please, and sometimes those things feel like they're at odds with each other, you know, if you're doing work for social good it often doesn't have immediate commercial appeal but if you're trying to do social good, you need to create something that's scalable, that you can disseminate in a wide-scale manner so that it reaches as many people as possible and to do that you often have to appeal to the kind of profitability element of something, right, that was the whole reason we formed a spin out company because you create something, you develop an evidence-base for it in academia, and then how do you get it out there to people, right? You have to have some way of disseminating it that is not dependent on the NIH funding cycle or the limitations of what that funding can be used for, right? So, very reasonably NIH isn’t interested in covering the cost of your servers or your push notifications or updating your software or something like that and so you kind of commercialize to be able to do those things at the same time if you're really driven by doing social good and by scientific curiosity that's not necessarily something that's appealing to investors. I think that there are investors that care about social good but the bottom line is really what investors are concerned about because they're looking for return on their investment and so I think the PInCh is a really nice opportunity to combine those two things, to be cognizant of science and social good, but at the same time be thinking about how you can take those elements to create a product that has some commercial value as well, so I think those opportunities are becoming more common but they’re still fairly new and it's really nice to have something like that at Pitt. I really appreciated that.

Mike: In 2015, Chancellor Pat Gallagher addressed the University community in an article titled, “Making an Impact through Commercialization” where he emphasized the importance of moving research from the lab or clinic into new and improved products or services in the marketplace that can ultimately benefit society.

Tamar is pursuing a path to impact that involves commercialization and is well on her way to making a difference, not just for women in Pittsburgh but for women all over the world.    

Mike: Do you have any particular hobbies outside of the work that you were doing? Today you mentioned some earlier adventures when you were in college, you know, traveling the world, any similar adventures or other activities that you try and do?

Tamar: COVID has put a real wrench in the works of travel. But I do love traveling whenever I can. I have two kids, a nine year old and a four-year-old, and so right now they are taking up every minute of my free time but yeah, I mean hobbies I still play the piano though not in the serious way that I used to, and I'm an avid reader so I will sneak in a good book whenever I can.

Mike - Any particular type of books or reading that you do?

Tamar. No. pretty much anything I can get my hands on although I'm pretty into the mystery novels when I'm traveling. Total brain relaxation. My true guilty secret of what I do in my spare time which is that I pour over interior design blogs but I'm not sure that that's going to make the cut of your final podcast.

Mike: Hey, I think that is interesting. You’d be surprised. I think the most unique and most appealing aspects of these conversations are some of these personal kind of elements that maybe no one would have expected. So, I'm curious to learn more, so you peruse interior design pages?

Tamar: I’m totally obsessed with interior design. Home renovation. Patents of the housing market they have nothing to do with my scientific life but I find them totally fascinating so if I'm not reading a good book, I’m definitely thinking about color palette and demolition.

Mike: Well, I mean you do incorporate design in aspects of your work maybe not necessarily interior design or color palettes but it sounds like there's elements of design in a lot of the research that you do.

Tamar: Yea, absolutely. I think if you want to build a tool that people will actually use then you have to make it engaging. Engagement is the elusive kind of multibillion-dollar problem, right? You can build as many things as you want but if you can't get people to use them then they’re just going to sit on a shelf. How do you build the Twitter for health tools, right? Something that keeps people coming in, you go through it quickly, it's exciting, it’s constantly changing, and with health problems, especially chronic problems, you often are requiring people to do the same things and engage in kind of lengthy interactions, right, with things that they may psychologically actually want to distance themselves from certain times and so, yeah, design is really important and design that takes into account human psychology so you're right I think designing a space or thinking about how people interact with their environment in their home is actually probably not that different from thinking about how they interact with a health tool, yeah.

Mike: Would be an interesting TV show, I guess, is the color pallets and design of a clinic or something like that.

Tamar: Yeah that’s true, I’m doing work right now with the Pittsburgh Study I'm not sure if you're familiar with it. We're working with, we call ourselves the Pittsburgh Study Pregnancy Collaborative and our group is composed largely of community members but it's a collaborative of community members and researches, and the work we’re doing right now is really trying to understand, in Pittsburgh, through kind of health equity lens, what does it mean to have a healthy pregnancy? What does that look like, not just physical health outcomes but the whole process of being pregnant. What are the elements of your environment, your personal life, social support, your own internal experience, that make you feel like you are thriving in that pregnancy, and so I'm mentioning this because interestingly when we talk to people and we are currently running a large survey in the community to try and help define this but one of the things that comes up when we talk to people is just how they feel in certain physical spaces, right? So, how does it feel sitting in a WIC office? How does that feeling really affect how you spend the rest of your day, right? Not even the social interaction but the physical environment. Does it feel welcoming? Do you feel like you have a right to be there in that you feel supported by the place that you're sitting in, all the services that you're receiving, the people that you're interacting with so it's really interesting.

Mike: If you could select one word to describe yourself what would that one word be?

Tamar: Hmmm…Determined, I think. I think I'm very determined. I wish there was a different word actually like I think that part of why I'm determined is that I'm always kind of questioning the direction I'm going. I mentioned I'm very driven by curiosity and I think I've always been quite envious of those people that really know exactly what they're doing and why. I feel like I’m driven by curiosity and problem-solving but not necessarily that I have some overarching kind of direction in which I want to take myself and so when I do think of something I want to do I'm very determined to succeed at it.

Tamar Krishnamurti, PhD, Assistant Professor of Medicine and Clinical and Translational Science at the University of Pittsburgh. That’s our show, thank you for listening to The Products of Pittsburgh. Be sure to check out our website at www.ctsi.pitt.edu/podcast to hear more episodes as well as learn about CTSI programs and services. I’m Mike Flock, along with Zach Ferguson. Until next time, on The Products of Pittsburgh.