Reflection on the NAM Fellowship in Pharmacy
An Interview with Dr. Jonathan Watanabe, 2016-2018 Fellow
Jonathan H. Watanabe, PharmD, PhD, is an Associate Professor of Clinical Pharmacy in the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California, San Diego. His research at UC San Diego focuses on pharmaceutical economic policy and health outcomes to improve health at the population level by examining how to improve medication-related health outcomes, particularly for the elderly and underserved populations. Dr. Watanabe is involved in patient care at a skilled nursing facility and a program of all-inclusive care for the elderly, so much of his current focus is on reducing high-risk medication use in older adults.
Dr. Watanabe is the recipient of the third NAM Fellowship in Pharmacy, which was established in 2012. The Fellowship enables talented early-career health science scholars to participate in evidence-based health care and public health studies that affect the American people. Through direct involvement in the work of the National Academies of Sciences, Engineering, and Medicine (the National Academies), the Fellowship provides the opportunity to study health care challenges from a range of disciplines and viewpoints to develop sound health care strategies and policies.
In the following interview, Dr. Watanabe reflects on his current fellowship experience to date, the impact that this unique opportunity has had on his career, and advice for future Fellows.
How did you hear about the NAM Fellowship, and what motivated you to seek nomination?
I learned about the NAM Fellowship in Pharmacy through communications from the American Association of Colleges of Pharmacy (AACP) – but I’ve been following the activities of the NAM closely ever since I graduated from the University of Washington (UW). The first President of the Institute of Medicine (now the NAM), Dr. John Hogness, was a UW professor, and his name and legacy of unflinchingly examining our health care system to improve care quality were omnipresent at UW, so I have always been interested in participating in the work of the NAM. The Fellowship presented the perfect opportunity to do just that. Moreover, Dr. Palmer Taylor – one of my incredible mentors and the dean emeritus at UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences – is an NAM member. He reached out to ensure that I would be interested in becoming an NAM Fellow in Pharmacy and nominated me for the Fellowship.
What does the NAM Fellowship in Pharmacy entail?
The Fellowship is a part-time commitment, so it allows me to retain my faculty appointment at UC San Diego while devoting about 20% of my time over two years to participate in programs at the NAM and the National Academies. I am assigned to support the Board on Health Care Services, where I have been involved with a number of their ongoing consensus studies and workshops, including Making Medicines Affordable: A National Imperative. I also participated in Improving Diagnosis in Health Care: An Implementation Workshop and a workshop on Examining the Impact of Real-World Evidence on Medical Product Development. I will spend the latter half of my Fellowship supporting the Roundtable on Quality Care for People with Serious Illness, a follow-on workshop to the Impact of Real-World Evidence on Medical Product Development, and a consensus study focused on health care services related to cancer management. (Pictured: The Making Medicines Affordable consensus committee, with Watanabe shown far left).
How have you contributed to the work of your assigned board/committee/roundtable/forum during your current tenure as an NAM fellow?
My research is in pharmaceutical economics and outcomes, so serving as a Fellow for the committee that wrote Making Medicines Affordable: A National Imperative was ideal. I was the sole pharmacist involved with the committee and the report, so there was a lot for me to contribute.
During the committee meetings, I presented to the distinguished committee members and staff on aspects related to determining the value of medications, listed prices, reimbursement, patient assistance programs, generic medications and biosimilars, medication financing in other countries, federal programs including the orphan drug act, and Medicare and Medicaid. Many of these topics that were salient to the report related to areas of my research. I contributed to the writing of the report on several of these aspects, as well as on the role of clinical pharmacists in required reviews of medications for Medicare Part D recipients. To say I relished this work is probably an understatement.
I was also able to participate in a number of workshops, which convene stakeholders from a wide variety of disparate fields and specialties to facilitate discussion. One notable workshop was on Practical Approaches for Examining the Impact of Real-World Evidence on Medical Product Development. The topics covered in the workshop were closely related to my research on using observational data to improve care and better assess outcomes in actual practice. I was able to contribute to the dialogue on the importance of blinding in clinical trials and the relevance of incorporating future uncertainty related to clinical outcomes.
What are the top three highlights of your Fellowship experience?
It’s honestly a challenge to limit it to just three highlights.
Participating in the closed-door meetings of the committee that wrote Making Medicines Affordable: A National Imperative was an incredible experience. Being at the table with global luminaries, observing and participating in policy discussions as national health policy recommendations were crafted for a topic of that societal gravity was a once-in-a-lifetime experience.
The camaraderie and relaxing discussions I had with the staff led by Dr. Sharyl Nass and committee members led by committee chair Dr. Norman Augustine, will always be prized memories. We would begin working at 8:00 am and finish at 5:00 pm, and the days were full of the exchange of complex ideas and potential solutions, sprinkled with rigorous debate. At one meeting, I was able to have a fascinating discussion with committee member and former New Mexico Senator Jeff Bingaman while walking to dinner about how Congress had changed over his career, the importance of the issue the committee was addressing, and how he envisioned it succeeding. I can’t think of another pharmacy policy fellowship program on earth that could offer that experience.
I was able to have robust discussions with the actual authors of classic health research papers I had studied in graduate school. I quickly became used to saying, “I recall reading this in your paper, and I had this question…” The Fellowship was like having a living library of classic health research at my fingertips.
The Fellowship’s orientation week and health policy primer at AcademyHealth was incredible. Meeting with the other NAM Fellows as well as the array of trainees from other distinguished programs was amazing as well. These events took place just weeks before the 2016 Presidental election, so the opportunity to interact with Congressional staffers at that moment was exciting and enlightening.
Lastly, I received a copy of Making Medicines Affordable: A National Imperative report in the mail with a signed note from the study’s co-director. It felt great knowing that I was part of the effort to improve patients’ lives and that I was listed with the other Fellows and staff in the report as a contributor.
What impact has the Fellowship had on you, both professionally and personally?
So many doors have opened, and opened quickly, in terms of forging collaborations and follow-up efforts with scholars and decision-makers doing important work. I was able to connect with ‘do-ers’ in U.S. health care policy at all career stages. My time as a Fellow has also sprouted collaborative efforts with the AACP and the American College of Clinical Pharmacy. I continue to work with the two prior NAM Fellows in Pharmacy to embolden policy work in the field of pharmacy, and I was introduced to many NAM members who are pharmacists.
One of the greatest benefits of the Fellowship is that you are quickly connected to leaders in a variety of pharmacy and health organizations. The NAM concentrates luminaries in every field of health and medicine, so being a Fellow reduces the “activation energy” needed to meet key scholars, regulators, and thought leaders.
Knowing what you now know through your Fellowship experience, what advice would you give to other early-career professionals or emerging leaders about contributing to the future direction of health care?
Get involved early in policy discussions and start developing evidence-based solutions to propose. A notably rewarding aspect of the Fellowship for me so far has been the ability to participate directly in a consensus study that addressed one of my personal passions.
Societally, we absolutely need more pharmacists involved in shaping health policy as care becomes increasingly focused in outpatient settings. More pharmacists are now solely functioning in direct patient care roles, which will become ever more important with a graying U.S. population and a shortage of primary care providers.
Seek out mentors. You will find that the vast majority of thought leaders are remarkably humble and accessible, particularly if you bring ideas and solutions to the table.