The Audacity of Science

Science might not bring to mind the word “audacious”—to do something daring or bold—“but you know, the best science always is,” said Dr. Leslie Curry, PhD, MPH, a professor of public health (health policy) at Yale School of Public Health (YSPH). Curry’s Leadership Saves Lives study in 2017 was called exactly that when she and a team of researchers proposed it.

The study sought to reduce heart attack deaths by improving hospital culture. The researchers studied how staff at 10 participating hospitals worked together and communicated, how management supported them, and how they approached learning and problem solving. The researchers also provided a framework that helped the hospitals develop strategies to achieve better patient outcomes. The results were remarkable. “In just two years, hospitals that changed their culture saw fewer patients die from heart attacks—a 1% drop in deaths,” Curry said. “That’s the same life-saving impact as streptokinase, a breakthrough heart drug from the 1980s that revolutionized clinical practice.”

Leadership Saves Lives built directly upon foundational research funded by the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ). It offers a prime example of how government support of academic research can advance science in ways that foster innovation, improve patient care, and can save taxpayers millions in health care costs. At a time when billions of dollars of grants have been rescinded and the NIH has been targeted for a 44% budget cut, here are examples of NIH-funded science at YSPH that is making for a healthier world.

Please join us in shaping the future of public health.

While federal funding supports a large share of Yale School of Public Health’s research, philanthropic gifts also play a key role in helping sustain the school’s mission of advancing public health.

Make your gift today →

Environmental Pollution and Brain Development

Why do about 1 in 6 children in the United States face neurodevelopmental issues? Why is that number, roughly 17% of 3- to 17-year-olds, on the rise?

One answer may be the effects of environmental pollution on brain development and neurodevelopmental disorders, said Dr. Zeyan Liew, PhD, MPH. But this research field is still young—Liew’s PhD thesis in 2010 was the first published research connecting so-called ‘forever chemicals’ known as PFAS (per- and polyfluoroalkyl substances) with brain development. It’s also cross-disciplinary: Liew’s team at YSPH focuses specifically on how exposure to those endocrine-disrupting PFAS chemicals, air pollution, and medications impacts early life development, including physical, cognitive, and behavioral function. This requires working closely with teams that specialize in pregnancy health and child development.

Currently, Liew is trying to determine whether certain environmental pollutants create risks for autism, epilepsy, and cerebral palsy. He has a corollary question in mind: what do expectant mothers need to know about the conditions in their environment. “If we can identify toxic chemicals that are affecting maternal and child health, we can push through regulations or eliminate them from our living environment,” Liew said. “By removing these chemicals, we may be able to prevent the increasing trend of child-adverse conditions that we are witnessing right now.”

Can Diet and Exercise Make Chemotherapy More Palatable?

For many cancer patients, the treatment feels worse than the disease. In one recent study, 44 percent of women with ovarian cancer were unable to adhere to their prescribed chemotherapy regimen primarily because of side effects like extreme fatigue or gastrointestinal issues. Dr. Melinda Irwin, PhD, MPH, and her research team have been studying whether regular exercise and a healthy diet can counter the worst effects of chemotherapy, helping patients complete their course of treatment and giving them a better chance at survival.

Diet and exercise have been shown to help prevent cancer. But “there really isn’t a lot of evidence for the role of nutrition and exercise during cancer treatment and how it may improve treatment outcomes and survival,” said Irwin, whose early research provided some of the first evidence that physical activity and weight management are associated with cancer survival rates.

With NIH funding support over the past 16 years, Irwin’s research team was able to test multiple nutrition and exercise interventions shortly before, during, and after chemotherapy. The approaches improved patients’ physical functioning and fatigue, as well as biological markers of inflammation, metabolic, and immune function. But it is still unclear whether these interventions improve clinical outcomes, such as adherence to chemotherapy. Recently, she launched the Trial of Exercise and Lifestyle (TEAL) study, which is investigating the impact of medical nutrition therapy and exercise on treatment outcomes compared to the usual care provided to women diagnosed with ovarian or endometrial cancer. The findings from the trial, which is being funded by the NIH’s National Cancer Institute, could help make nutrition, exercise, and weight management a routine part of oncology care.

Transforming Ideas into Impact: The LAGO Method Explained

While randomized clinical trials are the gold standard for biomedical research, they often aren’t predictors of real-world success. To help make that more likely, Dr. Donna Spiegelman, ScD, and her team at the Center for Methods in Implementation and Prevention Science (CMIPS) used NIH funding to devise a new study design called Learn As You Go, or LAGO.

“We focus on methodologic development in addition to the practice of high-impact implementation science,” said Spiegelman. “Nobody else is doing this, not in the context of a center with a group of people all focused on that goal.” The work of bringing together experts from specialties such as biostatistics, big data computing, epidemiology, and health care delivery is what helps CMIPS develop new methods such as LAGO.

Studies using LAGO are carried out in stages. After each stage, the results that have been collected are analyzed, the intervention is reassessed, and a revised version is used in the next stage. That allows researchers “to identify the most cost-effective strategies and combinations of intervention packages as a study moves on,” said Dr. Fan Li, PhD, one of the YSPH scientists affiliated with the CMIPS program. “It was simply not possible to do this before.”

LAGO is currently being used for studies on HIV prevention, hypertension, and cardiovascular disease. The LAGO design is unique for the way it allows researchers to tweak, tailor, and adjust an intervention in real time until the study goals are achieved. This could include an optimal outcome rate, such as 80% under hypertension control, or 80% statistical power for the standard test of the overall intervention package. LAGO also allows interventions to be adapted to local contexts, which is critical to the relevance and dissemination of public health, as well as for global health equity. Ultimately, the LAGO design aims to reduce the risks of failure for interventions as they are expanded beyond their initial trial populations. The benefits of LAGO are also to save both time and money in achieving impactful outcomes.

A Next-Generation Malaria Vaccine

The world’s first malaria vaccines were recommended for use as recently as October 2021, but already the parasites that cause the disease are adapting to become more resistant to their effects. “We currently have two malaria vaccines, which is really exciting and a real accomplishment for the field, but they still have their challenges such as modest efficacy that wanes over time,” said Dr. Amy Bei, PhD, an associate professor of epidemiology at YSPH. However, these challenges represent an opportunity for innovation in the development of next-generation vaccines. Malaria killed just under 600,000 people in 2023.

To improve malaria surveillance and prevention and with support from the NIH, Bei established a field lab in Senegal to identify genetic mutations in malaria parasites. She and her research team, including Senegalese scientists, take blood samples directly from malaria patients and analyze them with cutting-edge technologies—right in the field. This approach allows them to quickly identify and test emerging genetic mutations that could help the parasites evade the protective immune responses generated by current vaccines. The information and insights the researchers are gathering will help vaccine developers stay one step ahead of the evolving parasites and develop more durable and effective vaccines to prevent the disease. 

“This is something no one else is really doing quite in this way,” Bei said. “And it’s really important if we want to develop more broadly effective next-generation vaccines that will save lives from malaria.”

Bei’s research builds on deep local connection and a community-centered approach. Her team members engage in frequent discussions with community leaders, sharing data with and soliciting advice and guidance from local medical staff. Such long-term engagement and local commitment are important when conducting science in disease-endemic regions, Bei says. She and her team are actively working to empower a new generation of African scientists to lead the way in the discovery and development of new malaria vaccines.

Helping Hospitals Improve Patient Care

Dr. Leslie Curry, PhD, MPH, likes to compare research to creating a Jenga tower—new projects built on previous ones. Her work on the landmark Leadership Saves Lives (LSL) study, which improved outcomes for heart attack patients by transforming hospital culture, has led to the research she’s engaged in now to fight sepsis.

Sepsis, an infection that causes the immune system to attack tissues and internal organs, affects nearly 2 million people in the U.S. each year, killing approximately 350,000 annually. It’s also estimated to add a whopping $65 billion to our national health care costs every year. Severe sepsis occurs more frequently in Black and Hispanic populations, which also experience higher rates of deviations from standard care and more infection complications compared to non-Hispanic white populations. Curry and a team of YSPH researchers from Yale Global Health Leadership Initiative (GHLI), including GHLI Director Dr. Erika Linnander, DrPH, MBA, have been working with hospitals in Arizona, California, and Texas to improve performance and outcomes for patients with sepsis.

By analyzing how patient care teams work together, how treatment decisions are made and other factors along the sepsis care continuum pre- and post-hospitalization, the researchers hope to help the hospitals create strategies that reduce care discrepancies and improve outcomes.

“There's no way we could do this without NIH funding,” Curry said. “That funding allows us to support hospitals as they develop strong teams that function well together and have the problem-solving skills to create effective solutions that work.”

She added that “The real-world nature of this work is what makes it so powerful. It’s not ivory tower research. We’re sitting side-by-side with doctors, nurses, hospital leaders who are really trying to tackle sepsis.”