That Idea Stinks: Trust, Honesty, and the Importance of Team Science in Preventing Disease

Carl Marrs

Carl F. Marrs

Associate Professor of Epidemiology

 

Victor Hawthorne was interim chair of epidemiology when I was hired, and he suggested I sit in on the introductory epidemiology class my first semester—which I did! This was not a typical part of new faculty training in the department. In fact, I had never taken a formal epidemiology course in my life. But that’s the nature of how this department views epidemiological problem solving—they were more interested in preventing disease than in which degrees I had earned.

Historically, this department has understood that other disciplines, other realms of knowledge, are vital to understanding how diseases impact populations. The department has always had a major laboratory component, from its beginnings with virologist Thomas Francis to bringing in bacteriologist Pearl Kendrick to the groundbreaking influenza work of Hunein John Maassab, Arnold Monto, Emily Martin, and Aubree Gordon.

Historically, this department has understood that other disciplines, other realms of knowledge, are vital to understanding how diseases impact population.

So the department was not hiring anyone on the street with a PhD in science. In fact, they knew exactly what they were doing. Many other epidemiology programs around the country had reduced lab support over the course of the last century, responding to a general reduction in the toll of infectious diseases on human populations. Meanwhile, Michigan was rethinking and retooling. By the time I was hired in the 1980s—because of the resurgence in infectious diseases and a new awareness of antimicrobial resistance—there was renewed interest in molecular epidemiology.

Bovine Pink Eye Can Lead to Public Health

So this department, with its unique history and visions, hired me—a chemistry major with a PhD in genetics and molecular biology. I had just completed a postdoctoral fellowship with Stanley Falkow studying bacterial pathogenesis. That might sound good, but in truth, my research was so not public health. My doctoral dissertation was on transcribing the genome of a bacteriophage, a virus that infects bacteria. The focus of my postdoc research was the cloning and sequencing of a pilus gene from a cow-eye pathogen—the gene of a bacteria that causes pink-eye in cattle. This is not in any way a zoonotic infection that can spillover to humans. It is entirely a veterinary infection. My work was so not public health.

My work was so not public health.

As the only bacteriologist in the school, I realized quickly I would have to collaborate a lot in order to succeed. My first step was to reach out across the university to other bacteriologists, not just in microbiology but in immunology, infectious disease, and other related fields. I was very fortunate to work with Janet Gilsdorf, who was for a time director of Pediatric Infectious Diseases and eventually joined the School of Public Health faculty. Dr. Gilsdorf was doing work on a flu strain that can cause meningitis in infants and is the main cause of pediatric ear infections. And over the years, I worked with colleagues in the medical school, researchers in microbiology, bacterial geneticists in the dental school, and so on.

But I needed to connect within the department as well. In a conversation I had early on with Betsy Foxman about urinary tract infections (UTIs), she mentioned a recent discovery she had made. The factors determining the probability of a woman’s first UTI were not predictive for frequent recurrent infections. I casually speculated, “Maybe what matters is which bug caused that first infection.” Not knowing Dr. Foxman well at the time, I had no idea how a comment like that could lead to a 30-year collaboration. My work helped her answer some key questions about UTIs, and we were off and running.

I finished up work on those cow-eye bacteria grants, and being in a school of public health, began focusing more on human-oriented research. The natural collaborations I developed with Drs. Foxman and Gilsdorf on UTIs, influenza, and other infectious diseases would shape the rest of my career as I evolved to being primarily a collaborator. In fact, once Dr. Gilsdorf had joined the epidemiology faculty and the department was reorganizing space, she, Dr. Foxman, and I made sure our labs were adjacent. We decided to try developing new approaches and mechanisms for addressing population-level disease prevention.

We were part of the early wave of using high-throughput approaches, where you analyze lots of samples at once rather than just one at a time. Before genetic sequencing became so rapid and affordable, high-throughput sampling was the innovative technique for rapid disease detection.

 I might have become a world’s expert on a single pathogen or one kind of biological system. Instead, we’re addressing the need to develop ways to assess the hundreds of different strains of a single bacterial species.

If I had ended up in a microbiology and immunology department, I might have become a world’s expert on a single pathogen or a handful of pathogens or one kind of biological system. But instead, here at Michigan Public Health, we’re addressing the need to develop ways to assess the hundreds of different strains of a single bacterial species or, more recently, the wide array of different bacteria in complex communities within the human body.

Deep Care for Fellow Humans

While we were collaborating on research, we were also discussing how to recruit and train students who could learn all of our collective skill sets. Dr. Foxman came up with the idea of student training grants to give them more breadth in their work. And she brought in colleagues to train students on disease modelling, because she knew that was vital to epidemiology work.

When I got here, we didn't have a large student cohort in the Hospital and Molecular Epidemiology (HME). I knew the program would need more students, and I was already seeing how campus research collaborations were also a great way to let students—microbiology majors at Michigan, for example—know that we exist. Through a sheer willingness to connect with large numbers of prospective students, HME became known as a relatively unique program in the US. And we helped the campus navigate a complicated transition to a unique undergraduate microbiology major housed across three schools and five departments.

When undergraduates understand what public health is and how they can apply their undergraduate majors directly to population health, they often want to continue in public health.

I have worn several recruiting hats over the years. I became chair of admissions for the epidemiology department in 1992. It was something I was good at and am still doing it today. With my experience recruiting microbiology undergraduates and teaching and advising students in general, I also got involved early on with the School of Public Health undergraduate program—serving on planning committees and supporting recruitment.

The undergraduate initiative here at the school began late in my own career. And as I looked ahead to retirement, I thought it would be a rewarding legacy to be part of helping to get this program established. I and many others have transitioned our courses to become undergraduate courses, and it was just wonderful to graduate our first cohort last year in 2019. When undergraduates understand what public health is and how they can apply their undergraduate majors directly to population health, they often want to continue in public health.

“I’ve loved being in the School of Public Health from the beginning because the students are amazing.”

I’ve loved being in the School of Public Health from the beginning because the students are amazing. And over time, I came to understand why. It is clear to anyone who does their career research before they get here that you don’t go into public health as a graduate student to make money. You go into public health because you have a deep care for your fellow humans. Those are wonderful students who understand that and are motivated professionally by it. For this reason, whether we are recruiting new faculty or new students, it is easy to tell people this is a wonderful place to teach and to study.

I relish having had the opportunity to be a positive influence on student’s lives for so many years. It is very rewarding to be at graduation with a student completing their master’s or PhD degree and have them say, “I’ve known Carl since I was a freshman.”

I don’t have to be on a student’s doctoral committee to encourage them. I facilitate the weekly symposium for the Center for Molecular and Clinical Epidemiology of Infectious Diseases (MAC-EPID), where all doctoral students and postdoctoral fellows present. I get to know students across our epidemiology disciplines—evolution, ecology, pathogenesis, and transmission of infectious diseases—and we work together on understanding and modeling the kind of team science I have been doing with Dr. Gilsdorf, Dr. Foxman, and many others for decades.

Brutal Honesty Leads to Good Science

Team science requires a lot of grit, where collaborators trust each other enough that you don’t have to worry about hurting people’s feelings. With all due respect, we don’t always have time for some of my bad ideas or others’ bad ideas, so we just say to each other, “You know, that idea stinks.” And we move on to ideas that don’t stink. That grit and trust in each other helps us move more quickly toward solutions that actually help people.

Straight truth isn’t always easy on our emotions, but it is good for science.

We help students understand that the colleagues we’re closest to are those with whom we can interact in this more straightforward, honest way. When you consider what we’re working on in our labs—honesty and transparency are highly prized attributes. Straight truth isn’t always easy on our emotions, but it is good for science. Of course, my banter with colleagues is different than how I interact with students. Science is a challenging endeavor, and positivity is also important—between colleagues and with students.

I internalized from my doctoral mentor that getting something wrong means you're on your way to becoming an expert. My definition of an expert is someone who's made every conceivable mistake themselves and can therefore, at a glance, tell what went wrong. That’s the definition of science, in a way—trial and error.

When you work with other scientists, find some you trust enough that you can tell them which of their ideas stink. And make sure you trust them enough that you believe them when they tell you which of your ideas stink.

The biggest challenge of my career has also been the biggest joy—being faculty in a field and a department in which I had no formal training. But that’s public health! It was clear I would have to be the one to adapt to be successful, and I have had every support and opportunity here to do that. I challenged myself to make that transition, and I hope it has benefited the public’s health.


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