Spotlight on…Hilary Tindle

Spotlight On…Hilary Tindle

Hilary Tindle, MD, MPH, Co-Principal Investigator of the St. PETER HIV study and Associate Professor of Medicine at Vanderbilt University

As told to URBAN ARCH Admin Core staff, February 2017

l-r: Hilary Tindle, Quinn Wells, Matt Freiberg, and Madeleine Freiberg at the 2017 Society for Research on Nicotine and Tobacco Annual Meeting

Tell us more about your background. How did you become involved in alcohol, HIV, and smoking cessation research?

I was trained as a general internist in Chicago, where I grew up, and I met my husband (Matt Freiberg) while we were at the University of Chicago. We practiced as general internists for a few years before deciding we wanted to go into research. I was always drawn more to smoking cessation than alcohol. I imagine that was because my father died of pancreatic cancer, which was alcohol and smoking related, but I always blamed it more on the smoking, so I was very driven to focus on smoking cessation clinically. Matt and I later moved to Boston and did our fellowships at Boston University and Harvard University, respectively, where my main goal was to learn how to design and implement clinical trials. Through attending each other’s fellowship parties I met Jeffrey Samet, Rich Saitz, Curt Ellison, and many of the other faculty at BU. So I have known some of these investigators for 15 years, but we haven’t formally worked together until last year. The pieces of Jeffrey having the Russia ARCH cohort and Matt running the ZINC trial with him were all there, so the situation was just really ripe to propose a study that had both alcohol and smoking cessation outcomes – St PETER HIV.

You recently joined the Russia ARCH research team. How did that come about and how is this research different than other studies or teams you’ve been involved with?

This opportunity came about primarily because of the infrastructure that Jeffrey, Matt, Debbie, and the whole URBAN ARCH team had already built. I had also been learning more at scientific meetings, specifically the Society for Research on Nicotine and Tobacco, about cytisine. This medicine is chemically very similar to varenicline as it’s a partial nicotinic agonist, but it has a couple of distinguishing properties as well. Cytisine is generally better tolerated by patients and doesn’t have as many side effects, but it’s also very inexpensive. Additionally, there is evidence that as a partial nicotinic agonist, it could have efficacy for alcohol reduction. For a while I had been thinking about how to design a cytisine trial which could address both smoking and alcohol, and as I was formulating trial ideas, the evidence for partial nicotinic agonists to reduce alcohol consumption was mounting. By the time we had the opportunity last year, the conditions were all there for looking at cytisine in this vulnerable group of smokers.

The study population is another unique element. These participants are burdened by substance use, such as alcohol and opioids, as well as very high depression rates. I’ve dealt with that before in U.S. populations, but this group is more challenging simply due to the magnitude of everything they’re dealing with. I also have not run a study abroad before. It’s been wonderful to partner with the Russian team as well as U.S. members of URBAN ARCH, and I’m hoping to travel to Russia on the next trip. So for me what’s most exciting is that we’re testing a very inexpensive, potentially efficacious medicine that could have a positive impact simultaneously on two really important outcomes (alcohol and smoking) that matter for people living with HIV. Globally speaking, this is also a goal for low and middle income countries in general.

Your husband, Matthew Freiberg, is one of the PIs with you on the St PETER HIV study. What is it like working with him?

Even if he weren’t my husband, I would love working with Matt because he’s such a strong collaborator. This study is unique because we have 3 PIs, but it’s been awesome because Matt, Jeffrey, and I each anchor different parts of the study. Jeffrey and Matt have anchored the alcohol component, Matt also has the cardiovascular disease portions, and I’ve been able to focus on the smoking piece. At the same time, though, I’ve learned so much about alcohol. Even though I’ve long been interested in this topic, and have clinically treated alcohol use, I’ve never formally run a study that had alcohol reduction as its primary aim.

People ask if Matt and I argue, which only happens rarely. In my eyes there is no downside to the collaboration. There is never a time when I can’t ask him a question or get something straightened out… and I don’t have to wait for regular business hours to do so. We try to commute together a couple days a week, so we’re able to talk about this and other studies en route. It’s actually is a great way to go. I highly recommend it.

What advice would you give to physician investigators who are starting to build their careers?

My advice is to find a dedicated mentor who is well-established in a field you’re interested in. They don’t have to be the end-all, be-all perfect fit, but their interest has to overlap enough so that you can learn from them. I can’t stress how important it is to overlap significantly with your mentor at least in your early years, so that you can really benefit from the infrastructure and breadth of his or her knowledge and experience. In addition, it’s important to have fun while learning. All of my mentors were highly qualified, and I learned valuable things from all of them, but the ones that I probably learned the most from were those that I was able to socialize with outside of work. I think it’s important to have not only a working relationship, but occasionally do things together. Matt and I shared a mentor, Dr. Lewis Kuller, and he and his wife, Alice, would take us to the symphony and to dinner, and have us over for their 4th of July party every year. That’s something I also love about Jeffrey; he always finds ways to add some social component to the science. It makes the experience so much more fun and alive. Everyone in this business works very hard, so my advice is to find a mentor who you jive with not only in weekly meetings but outside of work as well. And write a lot of papers together!

Tell us something surprising about yourself.

I have a newfound interest in keeping bees. Bees are really big in Tennessee, and I recently joined the Nashville Area Beekeeping Association where I hope to learn the art of beekeeping. Bees are critical to the food supply. 1/3 of all the food we eat is generally from pollination that bees helped accomplish. Bees haven’t been doing well recently, and I’d like to try and save the world in my tiny backyard by putting up some bee boxes! I’m a little afraid of getting stung, but I’m attending these meetings to see if I’m ready to take the plunge. My parents had a beehive growing up, and my dad had built a plastic tube for them to travel inside, where they lived during the winter, to the outside. I remember as a young girl being mesmerized while watching these bees travel through the tube.

Another research interest of mine is the how the attitudes and beliefs that people live by every day translate into health behaviors. The internal medicine physician in me became fascinated by how these beliefs, which form very early in life, influence the behaviors later in life. They influence whether people start smoking, whether they are able to quit, and other important health outcomes. I wrote a paper using data from the Women’s Health Initiative looking at optimism and pessimism and hostility/anger on mortality outcomes in 100,000 women. Shortly after it was published I was approached to write a book about it. At first I thought it was a joke. But my book “UP: How Positive Outlook Can Transform Our Health and Aging” was published in 2013. It’s basically a lay version of the research and provides the 7 steps one could take to improve attitudes– a call to action for someone who is interested in positive change and looking for a road map.