Winter 2018

Getting to Know You...Dr. Karina W. Davidson

Dr. Davidson is a Professor of Behavioral Medicine in Medicine, Cardiology, and Psychiatry at Columbia College of Physicians and Surgeons. She also serves as the Executive Director of the Center for Behavioral & Cardiovascular Health, Vice Dean of Organizational Effectiveness at the College of Physicians and Surgeons, and Chief Academic Officer at NewYork-Presbyterian Hospital.

APS: Thank you for taking the time to chat. I know our readers are keen to hear what you have to say. First, can you tell us a bit about your career trajectory.  Were there any important decision points or moments that shaped where and who you are now in your career?

KD: I have always focused on following my intellectual passions, and supporting others to do the same, and these two forces have usually shaped my decision points. As you will hear from many other successful scientists, I also had important decision points in my career that were forced on me by circumstance, happenstance, and outside influences. Various factors led me to decide to take new jobs, or seek new opportunities -- I wanted my children to be near their father (in the U.S), or the fishing industry died in Nova Scotia while I was seeking tenure there. These cumulative experiences and decisions shaped who I am, and what I care about, but for each of us it is a unique journey. Many mentors helped me steer towards the intersection of what I was passionate about, and what I was able to accomplish. I had some terrific mentors, and I wish I could thank them all for what they did to help me in my career.

APS: You have run a lot of studies and written a bunch of papers.  Is there one that stands out to you as particularly meaningful?

KD: I had a bet with a statistician and a psychoanalytic supervisor of mine that defense mechanisms could not be reliably assessed. I must have run 15 studies and wasted almost 10 years on that bet. I lost, as we did (eventually) assess them reliably. Proving, once again, that one should never try and prove the null hypothesis. But seriously, I’m particularly proud of my team for managing not one, but two successfully conducted randomized clinical trials of depression management in patients with an acute coronary syndrome. Dr. Nancy Frasure-Smith once said to me “Design and conduct any depression trial with great care. If you have any sense, you will only do one.” She was right, as usual. The inside joke for our team was that these were a ‘bear’ to run. So, we called the second trial, affectionately of course, ‘CODIAC’. I have a nurse manager, Joan Duer-Hefele who in particular deserves sainthood/knighthood for getting us through that second, bear of a trial. Needless to say, we are running our third trial as we converse.

Davidson, K., & MacGregor, M. W. (1998). A Critical Appraisal of Self‐Report Defense Mechanism Measures. Journal of Personality, 66(6), 965-992.

Davidson KW, Rieckmann N, Clemow L, Schwartz JE, Shimbo D, Medina V, Albanese G, Kronish I, Hegel M, Burg MM. Enhanced Depression Care for Patients With Acute Coronary Syndrome and Persistent Depressive SymptomsCoronary Psychosocial Evaluation Studies Randomized Controlled Trial. Arch Intern Med.2010;170(7):600–608. doi:10.1001/archinternmed.2010.29

Davidson KW, Bigger JT, Burg MM, Carney RM, Chaplin WF, Czajkowski S, Dornelas E, Duer-Hefele J, Frasure-Smith N, Freedland KE, Haas DC, Jaffe AS, Ladapo JA, Lespérance F, Medina V, Newman JD, Osorio GA, Parsons F, Schwartz JE, Shaffer JA, Shapiro PA, Sheps DS, Vaccarino V, Whang W, Ye S. Centralized, Stepped, Patient Preference–Based Treatment for Patients With Post–Acute Coronary Syndrome Depression: CODIACS Vanguard Randomized Controlled Trial. JAMA Intern Med. 2013;173(11):997–1004. doi:10.1001/jamainternmed.2013.915

APS: Many may not know that you serve on the U.S. Preventive Services Task Force (www.uspreventiveservicestaskforce.org). Can you tell us about your experience and what it has meant to you?

KD: This has been professionally and personally a transformative experience for me. I was told that it was up to 20 hours a week of work, and those warning me of this were not wrong. I have loved this volunteer position—I suspect it will be the most important contribution in my career to improving the health and well-being of the public. I have learned so much, and have such terrific colleagues on the task force. I’m indebted to those who contribute to the evidence-base we review, and to the countless staff and volunteers who help us ensure we review all the evidence before coming to a final statement recommendation.

APS: Another important initiative you play a central role in is the NIH Science of Behavior Change.  Can you tell us a little bit about your involvement and why researchers should be paying attention?

KD: Science of Behavior Change (SOBC) aims to improve our understanding of human behavior change across a broad range of health-related behaviors. The consortium supports research that integrates basic and translational science and cuts across many disciplines including cognitive and affective neuroscience, neuroeconomics, behavioral genetics, and behavioral economics. SOBC establishes the groundwork for a unified science of behavior change that capitalizes on both the emerging basic science and the progress that can be made by creating a multidisciplinary team to tackle this large problem. SOBC is applying a rigorous experimental medicine approach to identify the mechanisms that drive behavior change, at the same time, setting the standard for how basic behavioral research can be done.

Researchers should pay attention to this endeavor because it is exciting discovery research, and a method that we believe should permeate our scientific approach to behavior change. I’m awe struck by the importance of the SOBC mission, and the pleasure our team at CBCH has in supporting the basic behavioral scientists in the consortium who are using an experimental medicine approach to discover the more fundamental, underlying mechanisms that drive our health behavior. Drs. Donald Edmondson and Jennifer Sumner have been critical in ensuring that this research keeps moving collaboratively and briskly along.

APS: Despite all of your administrative positions, you are a tremendously active researcher. What are you working on now that gets you most excited?

KD: I’m completely jazzed by our new high-risk, high reward Transformative R01 on precision therapeutics. Our team intends to tackle a transformation needed in the clinical encounter to aid in the advancement of precision medicine. Basically, we are going to build a digital healthcare platform so that N-of-1 trials can be ordered by clinicians and patients, to test best individualized treatments for blood pressure, depressive symptoms, and insomnia. And, this research really does take a team to tackle this ambitious goal. Drs. Ian Kronish and James Peacock are my partners in crime for this endeavor.

I’m also quite excited by the opportunities we have had to craft a bespoke executive physician leadership program with our hospital system, NewYork Presbyterian. This 18-month training program provides LEAD physicians with the highest-yield components of an MBA and MHA, all led by experts from nationally renowned educational institutions. Working with Dr. Lauren Wasson, we have had a great time developing and delivering innovative curriculum and education content. And, in our extensive interviewing process to identify ideal applicants, I was able to re-invoke my behavioral coding system for defense mechanisms. You never know when a few tricks of the clinical psychology trade will come in handy.

APS: I will readily admit that you have given me great advice over the years, so I’m wondering if there are any tidbits of insight you’ve gained over your career that you wish to pass on to graduate students, post docs, or junior faculty?

KD: Don’t compromise on your integrity. I’ve had times in my life when I did not speak up when I saw something was wrong, or someone was treated poorly. I live with regret for those moments. We live in a time when respect and civility are hard to come by in many situations. Speak up. Stand your ground. Thank those around you who do the same. It is hard in the moment, but you will sleep better at night.

APS: When you are not leading a cardiovascular behavioral medicine empire, what are you doing? Like, for fun?

KD: I’m afraid I’ll make someone jealous if I answer this honestly. Among other things, my fiancée and I have a bucket list of exotic destinations, and we have the goal of getting to two destinations a year. I’m off to bike in Quito and kayak around the Galapagos islands next week. In July, we were deep sea diving on the Great Barrier reef, and ‘ice snorkeling’ down a glacier-fed mountain stream in Northern Australia. We are committed to enjoying everything that New York has to offer, so we spend time at the Met Opera, and exploring the wilderness that is shockingly close to Manhattan (who knew cider tasting was only an hour away?). I have found—albeit a little later in life—that the more fun you have in your personal life, the more fun you have at work. Finally, I have to say I have the privilege to work with a stellar set of faculty, postdocs, managers, and staff members. Seeing them every day, and seeing all the ways they are succeeding in their careers, makes work and life pretty amazing.