Durham is also a vice president of research for Kaiser Permanente and conducts her own research on health care delivery and workplace health. She joined the center in 1995, taking over for Mitch Greenlick, who had been director since 1964, when the center started in a small basement office of a Kaiser Permanente hospital.
When Durham joined the center, it was a relatively small player on the national research scene, with a budget of about $13 million. Under her leadership, the budget has grown to nearly $50 million. With some 300 employees in two Kaiser Permanente regions, the center competes for federal grants with some of the nation’s most prestigious medical and academic institutions. It has become well known for its discoveries in the areas of weight management, cancer screening, diabetes, mental health, genetics, women’s health and health disparities.
In this interview, Durham discusses her tenure as the center’s director.
How has the center changed over the last 20 years?
When I moved from the Group Health Research Institute in Seattle, there was only one other woman researcher here at the Center for Health Research. Now we have more women researchers than men.
Most of the grants were written and the decisions made by a handful of people. I really wanted to give researchers more autonomy so I could focus on growing the center. I had a goal of doubling the budget in 10 years. We did that, and now our budget is about four times what it was when I started.
We compete against institutions like Stanford, Johns Hopkins and Harvard every day, and to compete at that level you have to have top scientists. When I came here it was harder to recruit qualified researchers because they didn’t want to move to Portland. Now everyone wants to move here, so it’s easier to recruit good people.
Another thing that’s changed is our ability to conduct studies involving racially and culturally diverse populations. I saw early on that we lacked this diversity in the Pacific Northwest, so in 1999 I worked with colleagues in Hawaii to create the Kaiser Permanente Center for Health Research-Hawaii. Hawaii has a lot of racial diversity, and also some of the highest and lowest rates of diabetes, heart disease and obesity, so it provides a very interesting study population. Our partnership has provided an excellent opportunity for research to improve the health of Asian and Pacific Islanders.
What is your most important role as research director?
In addition to overseeing our research, which involves hundreds of studies and the publication of about 200 scientific papers each year, one of my most important roles is telling the world about our research. I sit on the leadership team of Kaiser Permanente Northwest, so I get to share our work with local Kaiser Permanente leaders. I also give presentations outside of Kaiser Permanente to health care policy experts, academic institutions and employer groups.
I’ve been lucky to be a part of Kaiser Permanente International, a program that educates governments, health plans and health care providers around the world about Kaiser Permanente. I’ve traveled to places like Brazil and Sweden telling people about our integrated care model and how our research improves patients’ lives.
Can you share some examples of this research work?
One of my favorite examples is the work we’ve done to help providers predict which of the patients who have chronic kidney disease will go on to end-stage renal failure. Only a small proportion of patients with chronic kidney disease will have to go on dialysis, but those who do are are at higher risk for death. Dialysis is also costly for the health care system. Because of our work, Kaiser Permanente is now intervening early with these high-risk patients to help them reduce their chances of kidney failure.
We’ve also done a lot to help women manage their weight gain during pregnancy and to reduce their chances of developing gestational diabetes. More than half of women gain too much weight while pregnant, and this extra weight can lead to birthing complications and to their child being overweight or obese later in life. It also increases the likelihood of developing gestational diabetes, which has its own set of complications, including having to deliver the baby early.
Our research has also helped to improve colon-cancer screening, not just for our own patients but for underserved patients in the community. There are many patients who won’t go in for a colonoscopy because it’s invasive, expensive and time-consuming. Our research shows that an alternative at-home fecal test is an effective screening tool. We are making this ‘FIT’ test available to underserved patients who might otherwise forgo screening, and we are finding cancers that can be treated at an early stage.
What do you see as the future of research?
In the 10- to 15-year range I think that the information from genetic studies will be absolutely transformative. Today we are treating it as special information, but in the future, information on genetics and how it’s related to your health status or any particular decision in health care is going to be just as common as your height and weight. In the future we will be merging genetic, behavioral and health information to predict people’s future illnesses and treatment.
What are your plans in retirement?
I am intense in my professional and personal life, so I’ll have plenty of things to do in retirement. One of my passions is running. I’ve run a dozen marathons and when I retire I plan to run more. I love the quote from writer Allan Ripp: “Running gives my life a sense of rhythm.” That’s true for me, too. I solve problems when I’m running. It frees my mind and gives me more perspective about what’s important and what’s not.
My husband and I are going to live in Italy three months each year. This will give me a chance to become more fluent in Italian. And I will practice the piano more often. I’ve never lived in a house without a piano, but I haven’t had a lot of time to practice. Now I will.