Erin: I know it’s only been six years since you left Princeton, but are you headed in the direction you expected?
Josh: I knew going into Princeton that I wanted to become a doctor, but it was through experiences at Princeton and afterwards that I realized how I wanted to be involved with health system change outside of the clinical setting. Working with patients is very satisfying—you get to know people and have the short-term satisfaction of knowing you are helping that one person—but I’m also interested in the big picture of how our health system could work better for people battling disease.
Erin: What did you value most about the GHP experience at Princeton?
Josh: I liked the interdisciplinarity of GHP. In the pre-med curriculum, you end up taking more natural science courses, but as a Woodrow Wilson School major and a GHP student I took social science courses that offered different approaches and perspectives to health and healthcare. In GHP, there was a nice mix of natural sciences as well as anthropology and more critical perspectives. When you deal with complex issues such as those seen in Global Health, multidisciplinary perspectives are crucial.
Erin: Can you tell me more about your undergraduate internship and research experience.
Josh: Between my sophomore and junior years, while the Affordable Care Act (ACA) was being drafted and debated, I completed a health policy internship at a DC think tank, the Center for the Study of the Presidency & Congress. We sought to help policy makers incorporate public health system-focused solutions into healthcare reform. For my senior thesis, I conducted field research and quantitative analysis of health reform in Mexico. This senior thesis research experience challenged me in new ways. In 2001, Mexico had passed a comprehensive health reform aimed at achieving universal health insurance coverage. Although there weren’t major changes in individual health outcomes associated with implementation of the new health insurance program, there were reductions in health-related bankruptcy. Personally, this was the first time I had put in the work to understand a topic with the thoroughness expected of academic experts. GHP faculty connections and relationships opened the door for me to have a lot of fascinating conversations in Mexico at the government, health care provider, and individual-patient levels. The opportunity to see the health care delivery system and to talk to people on the ground-level led to a better research process and a more nuanced and interesting final project.
Erin: How have you been involved in health policy, health access, or universal health care reform since you left Princeton?
Josh: While in medical school, at the Icahn School of Medicine at Mount Sinai, I was involved with health policy and advocacy work with Doctors for America and Physicians for Human Rights. Two foci were to improve patient access to healthcare by increasing ACA enrollment and to bring more doctors into advocacy. I applied what I learned from my senior thesis research in Mexico to New York State. One of the big issues the Mexican government struggled with was making sure that people who were eligible would actually get enrolled in the program; with the ACA, there have been similar challenges related to enrollment. There are many things we can learn across systems about best practices. I also spent a summer in Lima, Peru conducting qualitative research with Partners in Health. We were implementing a program where community health workers provided home-based support for people living with HIV starting antiretroviral therapy. And I took a year off form medical school to complete the MBA program at the University of Cambridge Judge Business School. Learning about and conducting operations research in the UK provided fascinating insights into the National Health Service.
Erin: Tell me more about your MBA experience and your entrepreneurial pursuits.
Josh: While my MBA was a general management program, I was also able to pursue my interest in improving healthcare systems. One thing that I began to realize about myself while completing my MBA was that I want to shape health system change in a more immediate, tangible fashion, than I could achieve through research and advocacy activities alone, which are inherently focused on influencing policy makers. This was one of the reasons that I decided to learn more about entrepreneurship during my MBA. Through entrepreneurship, you can apply creativity and test ideas in days, weeks and months, rather than years and decades. If I can envision a new tool to help patients, put together a team of collaborators to build that tool, and convince investors to put resources toward develop that tool, I can move health forward in the shorter term.
Erin: So in addition to being a full-time Emergency Medicine Resident at George Washington University Hospital, you’ve also co-founded a healthcare start-up? Can you tell me more about your role at this company and what the “big idea” is?
Josh: My company is transformative.ai. We apply machine learning to predict sudden cardiac arrest. There are subtle changes to the heart’s electrical system that precede cardiac arrest, and computers can identify these changes before the trained eye of a cardiologist can spot them. Our predictive software program analyzes continuous EKG data—collected either in-hospital or at home—and issues a warning before the deadly event occurs, giving patients and clinicians time to prepare for life-saving but time-sensitive interventions like defibrillation. Our team is currently working with several hospitals in Europe to refine our algorithm and to develop the software that clinicians and patients will use. My co-founders are machine learning experts, while my role focuses on shaping how this technology could integrate with the existing healthcare system, both clinically and in terms of health economics. I am also working with our clinical research partners to set up the studies that we need to carry out before applying for regulatory approval. We are still developing our product, but it is very rewarding to attempt to bring a new tool to the health system that could improve patients’ lives.
Erin: Which components of the GHP program have stuck with you post-graduation. What skills—hard or soft—have translated to life after college?
Josh: That's a tough question. I grew quite a bit at Princeton, but it's hard to attribute skills to any one experience. Actually, one of my most formative times at Princeton came as Managing Editor of the Daily Princetonian. The writing, research, and collaborative skills I developed were more practical than many of my class assignments. The interview skills I honed at the paper prepared me for patient interactions more readily than most of my pre-med courses.
The other huge lesson I learned from Princeton, specifically through exploring complex, global health challenges in the classroom, is the need for humility. There is a law of unintended consequences: you can set up a system that makes sense on paper, but once it gets out to the world it can have perverse incentives that lead to the direct opposite of what you intended, or negative externalities. It’s always important to have humility about what you are trying to accomplish. Even if the project succeeds, what are the consequences that may occur? For example, with the cardiac arrest prediction system, our goal is to give patients a warning that would lower the chance of death following a sudden cardiac arrest. But one realization that shaped our decision to design this technology to be used only by patients at high risk of cardiac arrest is that if you give this technology to a patient that is otherwise healthy and just wants to have the latest gadget—if their overall risk of a cardiac arrest is low, you are going to have a lot of false positives. Even if the project goes to the right group of patients, there will still be false positives. What effect will this have on patient anxiety? What effect will this have on doctors? Will it have a “boy who cried wolf” effect for clinicians tired of hearing false alarms? So I always think, “even if this goes right, what can go wrong?”
Erin: What drew you to the field of Emergency Medicine, in particular?
Josh: As part of my day-to-day work in the Emergency Department, I interact with people who are worried about what is going on in their body or what is happening with a loved one. In that moment, doctors have an opportunity to provide comfort and assurance to help people get through really challenging times. I know from talking to friends and family that the time they spend in the ED is an experience that they sometimes remember for many years because it was traumatic or scary. I have an incredible opportunity to be the person who can make that experience more tolerable—and the conversations I have with my patients are ones they might remember for years.
Erin: Any thoughts, advice, or words of wisdom for current GHP students?
Josh: My biggest piece of advice to current students is to spend time doing the activities that you enjoy and develop skills outside of what you see as linear steps toward your chosen career. A lot of the skills you develop at Princeton are highly transferable. Although I knew early on that I wanted to go to medical school, I spent a low amount of time doing traditional pre-med activities that got me to that next hurdle. I was able to spend a lot of time doing activities that I enjoyed, which have influenced my career or enhanced my skills in unpredictable ways. For example, majoring in public policy at the Woodrow Wilson School; interviewing, writing, and editing for the Daily Princetonian; and learning to apply interdisciplinary methods with The Global Health Program have influenced the career choices I’ve made. College is the time to explore and experiment with things you are interested in trying; take advantage of what Princeton has to offer—especially the opportunities out of the bubble—going abroad, internships etc.